Individual provider Active NPI

Kelly L Nguyen, APRN

  • Family Nurse Practitioner
  • Andover, MN
National Provider Identifier
1063883338
Registry record updated Apr 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
6445 Issued in MN
Practice address
13819 Hanson Blvd NW
Andover, MN 55304-7608
Phone
(763) 392-4001
Fax
(763) 862-2091
NPI assigned
Oct 13, 2015
Last updated
Apr 4, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3009765 KY
Family Nurse Practitioner 363LF0000X 6445 MN Primary

Addresses

Primary practice location

13819 Hanson Blvd NW
Andover, MN 55304-7608

Mailing address

13819 Hanson Blvd NW
Andover, MN 55304-7608
Phone (763) 392-4001

Other identifiers 2

IdentifierTypeStateIssuer
201332080MedicaidIN
7100366930MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190718000292 MN Practitioner - Nurse Practitioner 2365752623 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
6445MNMDChiropractor
3009765KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Clinics CurrentSince Oct 2, 2020 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Oct 2, 2020 Accepting new patients
Fairview Health Services CurrentSince Jun 15, 2019 Accepting new patients
Fairview Health Services CurrentSince Jun 15, 2019 Accepting new patients

Locations

13819 Hanson Blvd NW
Andover, MN 55304
Phone (763) 572-5700

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1063883338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13819 HANSON BLVD NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553047608",
            "telephone_number": "763-392-4001",
            "fax_number": "763-862-2091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13819 HANSON BLVD NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553047608",
            "telephone_number": "763-392-4001",
            "fax_number": "763-862-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "KELLY",
        "middle_name": "L",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-13",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3009765",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "6445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201332080",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100366930",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, MN

Sources for this page

Verify at the official NPI Registry.