Kelly Underberg Johnson, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R 114150-2 Issued in MN

Practice address

400 E 3Rd St
SMDC Medical Center-Duluth Clinic
Duluth, MN 55805-1951

Phone

(218) 786-3925

NPI assigned

Jul 17, 2009

Last updated

Jun 20, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Kelly Underberg Former name

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Brainerd Medical Center Inc

  dba Essentia Health Brainerd Specialty Clinic

  • General Practice Physician
  • Brainerd, MN
  • NPI 1295801777
  Medicare reassignment NPD
• The Duluth Clinic LTD

  dba Essentia Health Cloquet Clinic

  • Multi-Specialty Clinic/Center
  • Cloquet, MN
  • NPI 1902563638
  Medicare reassignment NPD
• The Duluth Clinic, LTD

  dba Essentia Health Duluth Clinic

  • Multi-Specialty Clinic/Center
  • Duluth, MN
  • NPI 1245278209

  WI

  Medicare reassignment NPD
• St. Mary's Hospital of Superior

  dba Essentia Health St. Mary's Hospital Superior

  • Critical Access Hospital
  • Superior, WI
  • NPI 1083657886
  Medicare reassignment NPD
• Brainerd Medical Center Inc.

  dba Essentia Health Staples Pharmacy

  • Clinic Pharmacy
  • Staples, MN
  • NPI 1972350486
  NPD
• St Joseph's Medical Center

  dba Essentia Health St Josephs Staples Clinic

  • Multi-Specialty Clinic/Center
  • Staples, MN
  • NPI 1538916101
  NPD
• St. Joseph's Medical Center

  dba Essentia Health-St. Joseph's Medical Center

  • General Acute Care Hospital
  • Brainerd, MN
  • NPI 1568415974
  NPD
• St. Joseph's Medical Center

  dba Essentia Health St. Joseph's-Pine River Clinic

  • Primary Care Clinic/Center
  • Pine River, MN
  • NPI 1649223603
  NPD
• The Duluth Clinic, LTD

  dba Essentia Health Virginia Medical Arts Clinic

  • Multi-Specialty Clinic/Center
  • Virginia, MN
  • NPI 1538506894
  NPD
• The Duluth Clinic, LTD.

  dba Essentia Health Hinckley Pharmacy

  • Community/Retail Pharmacy
  • Hinckley, MN
  • NPI 1245081066
  NPD
• St Mary's Hospital of Superior

  dba Essentia Health Spooner Clinic

  • Rural Health Clinic/Center
  • Spooner, WI
  • NPI 1083161301
  NPD
• St. Mary's Duluth Clinic Health System

  • Clinical Medical Laboratory
  • Superior, WI
  • NPI 1205866928
  NPD

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

{
    "created_epoch": "1247788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308528000000",
    "number": "1114157625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "address_2": "SMDC MEDICAL CENTER-DULUTH CLINIC",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-3925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "address_2": "SMDC MEDICAL CENTER-DULUTH CLINIC",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-3925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "middle_name": "UNDERBERG",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-17",
        "last_updated": "2011-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R 114150-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114157625",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114157625",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114157625",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "UNDERBERG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Julie Ann Johnson, MS, LICSW
• Karen Dolores Johnson, RN
• Karen M Johnson
• Karys Olivia Johnson
• Kathryn Ann Johnson, APRN, CNP
• Kim Dixon Johnson, LP
• Larry W Johnson, CRNA
• Leslie A Johnson, PHARMACIST
• Lindsay Marie Johnson, FNP-C
• Makenzie Johnson

• Family Nurse Practitioner in Duluth, MN
• Providers in Duluth, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.