Active NPI
Kelly J Coughlin
- Registered Dietitian
- Coon Rapids, MN
National Provider Identifier
1124018676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1578
- Practice address
- 3960 Coon Rapids Blvd NW Ste 220
Coon Rapids, MN 55433-2589 - Phone
- (763) 236-8438
- NPI assigned
- Oct 26, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1578 | MN | Primary |
Addresses
Primary practice location
3960 Coon Rapids Blvd NW Ste 220
Coon Rapids, MN 55433-2589
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-9000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kcoughlin659556@excellian.direct.allina.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1578 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakewood Health System | Past | Accepting new patients |
Interoperability endpoints
- kcoughlin659556@excellian.direct.allina.com
Organizations & group practices 1
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.
-
- Community/Retail Pharmacy
- Pillager, MN
- NPI 1396519906
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717027200000",
"number": "1124018676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2925 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071321",
"telephone_number": "612-262-9000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3960 COON RAPIDS BLVD NW STE 220",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554332589",
"telephone_number": "763-236-8438"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COUGHLIN",
"first_name": "KELLY",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-26",
"last_updated": "2024-05-30",
"certification_date": "2024-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "1578",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kcoughlin659556@excellian.direct.allina.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/PDF/TXT",
"address_1": "3960 Coon Rapids Blvd NW Ste 220",
"city": "Coon Rapids",
"state": "MN",
"country_code": "US",
"postal_code": "554332589",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Coon Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.