Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly L Nickelson, PHYSICALTHERAPIST

Individual provider Specialist · NPI 1871780155

Kelly L Nickelson, PHYSICALTHERAPIST is a Physical Therapist in Private Practice in Fulton, Missouri. Qualified in 2002, 24 years ago. Practices with Central Missouri Physical Therapy LLC, a 53-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
24
Licensed in
MO
In the registry since
2007
Specialties on file
2
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Practice location Address checks out

401 Gaylord Dr
Fulton, MO 65251-2517
Phone: (573) 642-8541
Fax: (573) 642-8500
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 2002015010 (MO)
Specialist Taxonomy 174400000X · Licence 2002015010 (MO)

Record details

NPI number1871780155
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICALTHERAPIST
Sole proprietorNo
NPI enumeratedOctober 1, 2007
Last updated in NPPESApril 19, 2023
Certification dateApril 18, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Central Missouri Physical Therapy Llc — 53 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Fulton