KELLY JEANNE KNICKERBOCKER CNM
NPI 1912863416
Midwife in Rochester, NY

Q: What is Kelly Knickerbocker's NPI number?

The NPI number for Kelly Knickerbocker is 1912863416. It was assigned to this individual provider in the NPPES registry on December 29, 2025.

Q: What is Kelly Knickerbocker's specialty?

The primary specialty registered for this NPI is Midwife with taxonomy code 176B00000X.

Active since December 29, 2025PECOS Enrolled

1415 PORTLAND AVE STE 400, ROCHESTER, NY 14621(585) 922-4200(585) 922-4922 Get Directions Write a Review

NPPES record last updated: March 23, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 23, 2026, Dec 29, 2025 (2 updates tracked since 2025).

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About Kelly Jeanne Knickerbocker Cnm NPPES

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

KELLY JEANNE KNICKERBOCKER CNM (NPI 1912863416) is an individual midwife in Rochester, New York, licensed in New York (002473) and active in the NPI registry since December 2025. She is enrolled in Medicare PECOS, maintains 3 additional practice locations, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1912863416

Entity TypeIndividualFemale

Primary Taxonomy176B00000X

Provider Legal NameKELLY JEANNE KNICKERBOCKERCredential: CNM

Location Address1415 PORTLAND AVE STE 400Rochester, NY 14621-3022

Mailing Address100 Kings Hwy SRochester, NY 14617-5504

Phone(585) 922-4200

Fax(585) 922-4922

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateDecember 29, 2025

Last NPPES UpdateMarch 23, 20262 updates tracked since enumeration

NPPES CertifiedMarch 23, 2026

✔ NPI 1912863416 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMidwifeOther Service Providers

Taxonomy Code176B00000X

License✔ Licensed in NY · 002473

Definition

A Midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling, and support to a woman and her newborn throughout the childbearing cycle. A Midwife is a skilled and independent practitioner who has undergone formalized training. Midwives are not required to be nurses and may be trained via multiple routes of education (apprenticeship, workshop, formal classes, or programs, etc., usually a combination). The educational background requirements and licensing requirements vary by state. The Midwife may or may not be certified by a state or national organization.

1415 PORTLAND AVE STE 400, Rochester, NY 14621

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Secondary Practice Locations 3

Location 12000 Empire Blvd Ste 200Webster, NY 14580-1957 · Phone (585) 922-0374 · Fax (585) 922-4023

Location 2293 Upper Falls BlvdRochester, NY 14605-2184 · Phone (585) 922-0260 · Fax (585) 922-0240

Location 3222 Alexander St Ste 1100Rochester, NY 14607-4005 · Phone (585) 922-8585 · Fax (585) 922-8555

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 Jeanne Knickerbocker Cnm is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1850876343

PECOS Enrollment IDI20260402000722

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.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DANIELLE NANA EKUA ASSIBU-GILMORE CNM

Advanced Practice Midwife