Kimberly E Henderson, APRN, CNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

996 Issued in MN

Practice address

520 NW 5TH St
Brainerd, MN 56401-2902

Phone

(507) 884-4856

NPI assigned

Feb 15, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ketchikan Indian CorporationGroup PAC ID 8426043761, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

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.

• Ketchikan Indian Corporation

  dba KIC Tribal Health Clinic

  • Primary Care Clinic/Center
  • Ketchikan, AK
  • NPI 1821120486

  TX

  Medicare reassignment Care Compare group
• Bluebirds & Daffodils, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Brainerd, MN
  • NPI 1790497865
  NPD (past) Authorized official

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673308800000",
    "number": "1114991361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 NW 5TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564012902",
            "telephone_number": "218-829-3235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 NW 5TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564012902",
            "telephone_number": "507-884-4856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KIMBERLY",
        "middle_name": "E",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-15",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "313637000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bryan James Hedlund, D.C.
• Joshua James Heldt, HID
• Marcie Heldt, HID
• Catrina Kay Helseth, LICSW
• Amanda Hemmila, PHARMD
• Mary H Henderson, PTA
• Peter John Henry, MD
• Rebecca Herman
• Katierae E Herron, APRN,CNP
• Patricia Josephine Herron, APRN, BC, CNS

• Psychiatric/Mental Health Nurse Practitioner in Brainerd, MN
• Providers in Brainerd, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.