Active NPI
Emma Grace Fenner, MD
- Child & Adolescent Psychiatry Physician
- Saint Paul, MN
National Provider Identifier
1184183220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 76622
- Practice address
- 345 Smith Ave N
Saint Paul, MN 55102-2346 - Phone
- (651) 220-6000
- NPI assigned
- Mar 18, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 76930-20 | WI | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 76622 | MN | Primary |
Addresses
Primary practice location
345 Smith Ave N
Saint Paul, MN 55102-2346
Mailing address
345 Smith Ave N
Saint Paul, MN 55102-2346
Phone (651) 220-6000
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 76930-20 | WI | MD | Psychiatry Physician |
| 76622 | MN | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Childrens Health Care | Past | Accepting new patients |
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.
-
- Children's Hospital
- Minneapolis, MN
- NPI 1881793750
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720396800000",
"number": "1184183220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "345 SMITH AVE N",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551022346",
"telephone_number": "651-220-6000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 SMITH AVE N",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551022346",
"telephone_number": "651-220-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENNER",
"first_name": "EMMA",
"middle_name": "GRACE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-18",
"last_updated": "2024-07-08",
"certification_date": "2024-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WI",
"license": "76930-20",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "MN",
"license": "76622",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.