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KELLY TICKLE PCNS-BC, PPCNP-BC
NPI 1417379538
Nurse Practitioner - Pediatrics in Atlanta, GA

Active since January 08, 2014PECOS Enrolled
5455 MERIDIAN MARKS RD STE 400, ATLANTA, GA 30342(404) 785-3240(404) 785-3600 Get Directions Write a Review

NPPES record last updated: October 31, 2025. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Kelly Tickle Pcns-bc, Ppcnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY TICKLE PCNS-BC, PPCNP-BC (NPI 1417379538) is an individual pediatrics provider in Atlanta, Georgia, licensed in Georgia (APRN-NP228738) and active in the NPI registry since January 2014. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1417379538
Entity TypeIndividualFemale
Primary Taxonomy363LP0200X
Provider Legal NameKELLY TICKLECredential: PCNS-BC, PPCNP-BC
Location Address5455 MERIDIAN MARKS RD STE 400Atlanta, GA 30342-4723
Mailing Address5455 Meridian Marks Rd Ste 400Atlanta, GA 30342-4723 · (404) 785-3240 · Fax (404) 785-3600
Phone(404) 785-3240
Fax(404) 785-3600
Sole ProprietorYes
Enumeration DateJanuary 8, 2014
Last NPPES UpdateOctober 31, 2025
NPPES CertifiedOctober 31, 2025
✔ NPI 1417379538 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0200X
License✔ Licensed in GA · APRN-NP228738
Also ListedRegistered NurseTaxonomy 163W00000X · License RN228738 (GA)
Also ListedClinical Nurse Specialist · PediatricsTaxonomy 364SP0200X · License APRN-CNS228738 (GA)
5455 MERIDIAN MARKS RD STE 400, Atlanta, GA 30342
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Tickle Pcns-bc, Ppcnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30342 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.06 typical visit price
range $56.84 – $172.43
Typical copayment $22.01 (range $14.21 – $43.10)
Most-billed visit code 99203
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Tickle's NPI number?

The NPI number for Kelly Tickle is 1417379538. It was assigned to this individual provider in the NPPES registry on January 8, 2014.

Where is Kelly Tickle located?

Kelly Tickle practices at 5455 Meridian Marks Rd Ste 400, Atlanta, GA 30342. The listed phone number is (404) 785-3240.

What is Kelly Tickle's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Is Kelly Tickle enrolled in Medicare?

Yes. Kelly Tickle is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kelly Tickle was last updated on October 31, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.