Kelly L. Nickelson, PHYSICAL THERAPIST
NPI 1871780155ActiveIndividual· Physical Therapist· Fulton, MO
Physical Therapist (PHYSICAL THERAPIST) with Boone Physician Services LLC and 1 other group, practicing in Fulton, Missouri. Medicare paid $39,139 for services to 95 patients in 2024.
Overview
| NPI | 1871780155 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PHYSICAL THERAPIST |
| Sole proprietor | No |
| NPI issued | Oct 1, 2007 |
| Last updated in NPPES | Apr 19, 2023 |
| Certified by provider | Apr 18, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 2002015010 | MO |
| Specialist | 174400000X | 2002015010 | MO |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (MO) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 95 |
|---|---|
| Services billed | 1,972 across 10 procedure codes |
| Paid by Medicare | $39,139 |
Education and affiliations
| Graduation year | 2002 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical groups
- Boone Physician Services LLCColumbia, MO · 250 clinicians
- Central Missouri Physical Therapy LLCColumbia, MO · 62 clinicians
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