Kelly Roberto, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

7676 Issued in MN

Practice address

2196 White Bear Ave N
Maplewood, MN 55109-2708

Phone

(651) 704-0322

NPI assigned

Nov 3, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989

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.

• Group Health, Inc.

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1710924683
  NPD (past)

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

{
    "created_epoch": "1604361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1124629464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2196 WHITE BEAR AVE N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551092708",
            "telephone_number": "651-704-0322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2196 WHITE BEAR AVE N",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551092708",
            "telephone_number": "651-704-0322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTO",
        "first_name": "KELLY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-03",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "7676",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "7676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CNP",
            "identifier": "7676",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leslie Denise Ritenour
• Stacia A Rivers, MD
• Shari Robbins, MD
• Robert J Sevenich M.D.,J.D.,P.a.
• Tyller Robert
• Chris A Rodahl
• Denise Bloczynski Rodiles, MA, LMFT
• Angela Roeser, LPN
• Carol Rogers-Tanner, MS LP
• Janessa Nicole Romain

• Family Nurse Practitioner in Maplewood, MN
• Providers in Maplewood, 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 May 18, 2021; 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.