Kimberly C Bourassa, DNP, APRN, PMHNP-BC

Key facts

NPI

1104590660

Entity type

Individual (NPI type 1)

Primary specialty

Psychiatric/Mental Health Nurse Practitioner 363LP0808X

License

9071 (MN)

Practice address

327 Marschall Rd Ste 250
Shakopee, MN 55379-2666

Phone

(651) 769-6500

NPI assigned

Aug 6, 2021

Sex

Female

Sole proprietor

No

Organizations & group practices 3

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

• Fraser Child and Family Center Adolescent and Children Mental Health Clinic/Center · Minneapolis, MN · NPI 1609922194
  Medicare reassignment Care Compare group NPD MN
• Bhsi, LLC Clinical Psychologist · North Saint Paul, MN · NPI 1174635643
  Medicare reassignment NPD MN
• Fraser Rehabilitation Clinic/Center · Richfield, MN · NPI 1063568574
  NPD (past)

Medicare Care Compare profile

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fraser Child and Family Center (54 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 6, 2026.

{
    "created_epoch": "1628208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778025600000",
    "number": "1104590660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 MARSCHALL RD STE 250",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553792666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 MARSCHALL RD STE 250",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553792666",
            "telephone_number": "651-769-6500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3460 Washington Dr",
            "address_purpose": "LOCATION",
            "city": "Eagan",
            "state": "MN",
            "postal_code": "551221338",
            "country_code": "US",
            "telephone_number": "651-769-6200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURASSA",
        "first_name": "KIMBERLY",
        "middle_name": "C",
        "credential": "DNP, APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-06",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "9071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Shakopee, MN · Psychiatric/Mental Health Nurse Practitioner in Minnesota