Individual provider Active NPI

Kelly Thomas Young, NP

  • Nurse Practitioner
  • Burnsville, MN
National Provider Identifier
1154732360
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2326 Issued in MN
Practice address
14000 Fairview Dr
Burnsville, MN 55337-4571
Phone
(952) 993-8700
Fax
(952) 993-8516
NPI assigned
May 12, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R 168856-0 MN
Family Nurse Practitioner 363LF0000X CNP2326 MN
Nurse Practitioner 363L00000X 2326 MN Primary

Addresses

Primary practice location

14000 Fairview Dr
Burnsville, MN 55337-4571

Mailing address

8170 33Rd Ave S
Ms 21110Q
Bloomington, MN 55425-4516

Other practice location 1

1580 Beam Ave
Maplewood, MN 55109-1127
Phone (651) 255-8480

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20140910000826 MN Practitioner - Nurse Practitioner 7416176250 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

1415 Saint Francis Ave
Shakopee, MN 55379-3374
Phone (952) 993-7750

15350 English Ave
Apple Valley, MN 55124-6252
Phone (952) 431-8500

1654 Diffley Rd
Suite 100
Eagan, MN 55122-2237
Phone (651) 641-3900

1885 Plaza Dr
Eagan, MN 55122-2979
Phone (952) 993-4001

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 221-3456

8325 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5868

8450 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5300

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

Hospital & facility affiliations

  • St Francis Regional Medical Center Hospital, Shakopee, MN, CCN 240104
  • Regions Hospital Hospital, Saint Paul, MN, CCN 240106
  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053
  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CNP2326MNMDFamily Nurse Practitioner
R 168856-0MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Current Accepting new patients
Group Health, Inc. Current Accepting new patients
Minnesota Oncology Hematology, PA PastSince Jan 12, 2020 Accepting new patients
Minnesota Oncology Hematology, PA Nurse Practitioner Past Accepting new patients
Minnesota Oncology Hematology, PA Family Past Accepting new patients

Locations

14000 Fairview Dr
Burnsville, MN 55337
Phone (952) 993-8608

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

Organizations & group practices 5

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.

Hospital & facility affiliations 38

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1154732360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14000 FAIRVIEW DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374571",
            "telephone_number": "952-993-8700",
            "fax_number": "952-993-8516"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1580 Beam Ave",
            "address_purpose": "LOCATION",
            "city": "Maplewood",
            "state": "MN",
            "postal_code": "551091127",
            "country_code": "US",
            "telephone_number": "651-255-8480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "KELLY",
        "middle_name": "THOMAS",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-12",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R 168856-0",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "CNP2326",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "2326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

Verify at the official NPI Registry.