Active NPI
Dawn M Kerridge, CNP
- Family Nurse Practitioner
- Minnetonka, MN
National Provider Identifier
1194132472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- CNP-02453
- Practice address
- 9900 Bren Rd E
Minnetonka, MN 55343-9664 - Phone
- (505) 967-9549
- NPI assigned
- Jul 17, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | CNP-02453 | NM | Primary |
Addresses
Primary practice location
9900 Bren Rd E
Minnetonka, MN 55343-9664
Mailing address
9900 Bren Rd E
Minnetonka, MN 55343-9664
Phone (505) 967-9549
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 45756325 | Medicaid | NM | |
| F0714186 | Other | AANP |
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
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP-02453 | NM | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601337600000",
"number": "1194132472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9900 BREN RD E",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553439664",
"telephone_number": "505-967-9549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9900 BREN RD E",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553439664",
"telephone_number": "505-967-9549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERRIDGE",
"first_name": "DAWN",
"middle_name": "M",
"credential": "CNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-17",
"last_updated": "2020-09-29",
"certification_date": "2020-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NM",
"license": "CNP-02453",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "45756325",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AANP",
"identifier": "F0714186",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.