Lori L Kelly, RN, CNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

R1533479 Issued in MN

Practice address

2845 Hamline Ave North
Roseville, MN 55113

Phone

(651) 631-6100

Fax

(651) 631-6343

NPI assigned

Jun 28, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner, Registered Nurse

State licenses

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335312000000",
    "number": "1235167503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 HAMLINE AVE NORTH",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "651-631-6100",
            "fax_number": "651-631-6343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 HAMLINE AVE NORTH",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "651-631-6100",
            "fax_number": "651-631-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "LORI",
        "middle_name": "L",
        "credential": "RN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2012-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "R1533479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "474957000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Stuart Kaufenberg, PT
• Bryan Kavanaugh
• KB Nutrition Counseling
• Douglas Kenneth Keim,, D.D.S.
• Charles E Kelly, MD
• Laura Marie Kelzer, RN
• Robert Bach Kennedy, OD
• Lawrence H Kent, DDS
• Marnie Justine Kerels, RN
• Maya Rose Kern, LGSW

• Gerontology Nurse Practitioner in Roseville, MN
• Providers in Roseville, MN by specialty
• Gerontology Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.