Kacey Retterath, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

817248 Issued in MN

Practice address

10467 93Rd Ave N
Maple Grove, MN 55369-4112

Phone

(651) 488-4655

Fax

(651) 488-4656

NPI assigned

Feb 6, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1580947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580947200000",
    "number": "1114559390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10467 93RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694112",
            "telephone_number": "651-488-4655",
            "fax_number": "651-488-4656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10467 93RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694112",
            "telephone_number": "651-488-4655",
            "fax_number": "651-488-4656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETTERATH",
        "first_name": "KACEY",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-06",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MN",
            "license": "817248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "651-488-4655",
            "affiliation": "N",
            "address_1": "10467 93rd Ave N",
            "city": "Maple Grove",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553694112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Licensed Practical Nurse in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Licensed Practical Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.