Active NPI
Kristina Kay Thissen, PA-S
- Medical Physician Assistant
- Rogers, MN
National Provider Identifier
1184069304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 21395 John Milless Dr
Rogers, MN 55374-4402 - Phone
- (763) 504-6400
- Fax
- (763) 504-6410
- NPI assigned
- May 1, 2013
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | Primary |
Addresses
Primary practice location
21395 John Milless Dr
Rogers, MN 55374-4402
Mailing address
21395 John Milless Dr
Rogers, MN 55374-4402
Phone (763) 504-6400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367366400000",
"number": "1184069304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21395 JOHN MILLESS DR",
"city": "ROGERS",
"state": "MN",
"postal_code": "553744402",
"telephone_number": "763-504-6400",
"fax_number": "763-504-6410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21395 JOHN MILLESS DR",
"city": "ROGERS",
"state": "MN",
"postal_code": "553744402",
"telephone_number": "763-504-6400",
"fax_number": "763-504-6410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THISSEN",
"first_name": "KRISTINA",
"middle_name": "KAY",
"credential": "PA-S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-01",
"last_updated": "2013-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rogers, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.