Kellie Lynn Leblanc, APRN, FNP-C

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

7557 Issued in MN

Practice address

700 Decatur Ave North
Ste 109
Golden Valley, MN 55427

Phone

(612) 682-4912

Fax

(612) 682-4914

NPI assigned

Jul 16, 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Danielle Golden, Crna, PAGroup PAC ID 6305934597, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: advancedbrainbody.kellieleblank@159081.advancedmd-direct.com

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.

• Danielle Golden, Crna, PA

  • Adult Mental Health Clinic/Center
  • Vadnais Heights, MN
  • NPI 1598954687
  Medicare reassignment Care Compare group NPD
• Advanced Brain and Body Clinic PLLC

  • Specialist
  • Golden Valley, MN
  • NPI 1447816632
  Medicare reassignment NPD

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

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1124636063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 DECATUR AVE NORTH",
            "address_2": "STE 109",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "55427",
            "telephone_number": "612-682-4912",
            "fax_number": "612-682-4914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 DECATUR AVE NORTH",
            "address_2": "STE 109",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "55427",
            "telephone_number": "612-682-4912",
            "fax_number": "612-682-4914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBLANC",
        "first_name": "KELLIE",
        "middle_name": "LYNN",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-16",
        "last_updated": "2023-11-28",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "7557",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "7557",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "misty@manlovegroup.com",
            "affiliation": "N",
            "address_1": "13911 Ridgedale Dr Ste 110",
            "city": "Minnetonka",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553051773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Language Link Interpreting
• John M Larotonda III, ATC
• Lisa Laurent, PTA
• Learning Disabilities Association, Inc.
• Debra Suzanne Leavitt, LICSW
• Susan M Lechner, OTRL
• Nicole Lee
• Senia Helene Lee, OTR/L
• Harry Robert Schlussel Leeds, RN, DNP
• Legacy Care Home

• Psychiatric/Mental Health Nurse Practitioner in Golden Valley, MN
• Providers in Golden Valley, 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 Nov 28, 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.