Susan Lee Kissell, RN, CNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

R0665283 Issued in MN

Practice address

401 Carlson Parkway
Minnetonka, MN 55305-5387

Phone

(952) 992-3612

NPI assigned

Aug 7, 2006

Sex

Female

Sole proprietor

Yes

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

Practice roles

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.

• Evercare Collaborative Solutions Inc

  • Registered Nurse
  • Minnetonka, MN
  • NPI 1285686378
  NPD (past)

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314921600000",
    "number": "1245249259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5510 MOUNT NORMANDALE CURV",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554371022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 CARLSON PARKWAY",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055387",
            "telephone_number": "952-992-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISSELL",
        "first_name": "SUSAN",
        "middle_name": "LEE",
        "credential": "RN, CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-07",
        "last_updated": "2011-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "R0665283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1145878-00",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Warren King, L.AC.
• Surabhi Kiran
• Cody James Kirk
• Ryan Kirkland
• Jessica Kay Kisling, LPCC
• Gregory H Kjos, CRNA
• Janis Kristin Klecker, DDS
• Angela Diane Kleinedler, MA CCC-SLP
• Jennifer Kleinhans, LPCC
• Jan T Klimek, NP

• Gerontology Nurse Practitioner in Minnetonka, MN
• Providers in Minnetonka, 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 Sep 2, 2011; 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.