Individual provider Active NPI

Katelyn Marie Park Pritchard, PA-C

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1205463999
Registry record updated Jan 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13554 Issued in MN
Practice address
909 Fulton St SE
Minneapolis, MN 55455-4800
Phone
(612) 273-8383
NPI assigned
Mar 24, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13554 MN Primary

Addresses

Primary practice location

909 Fulton St SE
Minneapolis, MN 55455-4800

Mailing address

516 Delaware St SE # Mmc98
Minneapolis, MN 55455-0356

Other names 1

  • Katelyn Camp Former name

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
I20210126000525 MN Practitioner - Physician Assistant 1951715317 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians
Fairview Specialty ServicesGroup PAC ID 3072083286, 303 clinicians

Practice addresses (Care Compare)

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 672-7422

600 W 98TH St
Bloomington, MN 55420-4773
Phone (952) 881-2651

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic CurrentSince Jan 3, 2022 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Aug 10, 2024 Accepting new patients
University of Minnesota Physicians CurrentSince Aug 10, 2024 Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Aug 10, 2024 Accepting new patients
Fairview Express Care CurrentSince Aug 10, 2024 Accepting new patients
Fairview Express Care CurrentSince Aug 10, 2024 Accepting new patients
University of Minnesota Physicians CurrentSince Aug 10, 2024 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

14500 99th Ave N
Ste 100
Maple Grove, MN 55369
Phone (763) 898-1000

516 Delaware St SE
#98
Minneapolis, MN 55455
Phone (612) 625-5656

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

600 W 98th St
Minneapolis, MN 55420
Phone (952) 881-2651

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0769

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

Interoperability endpoints

  • Direct secure messaging: kpritchard1597186@fairview.direct-ci.com

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738022400000",
    "number": "1205463999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 DELAWARE ST SE # MMC98",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 FULTON ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554554800",
            "telephone_number": "612-273-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRITCHARD",
        "first_name": "KATELYN",
        "middle_name": "MARIE PARK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-24",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "CAMP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.