Kelly Krueger, APRN, CNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R1610305 Issued in MN

Practice address

18432 Kenrick Ave
Lakeville, MN 55044-9288

Phone

(952) 993-8800

NPI assigned

Oct 20, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593
  NPD

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

{
    "created_epoch": "1319068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479168000000",
    "number": "1215212261",
    "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": "55440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18432 KENRICK AVE",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449288",
            "telephone_number": "952-993-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUEGER",
        "first_name": "KELLY",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-20",
        "last_updated": "2016-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "R1610305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Kotval, MA, L.P.C.C.
• Robert J Koziol, PHARM D
• William Louden Krane
• Jennifer J. Krieg, PA
• Heather R Krueger, MD
• Tyler Morgan Kruse, DC
• Kenchiro Kue, DO
• David Kuehl, PSYD LP
• Kolby Kulas, DDS
• Mallory Kurkosky, MA, LPCC

• Pediatric Nurse Practitioner in Lakeville, MN
• Providers in Lakeville, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2016; 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.

Verify at the official NPI Registry.