Individual provider Active NPI

Amanda J Mickelson, CNP

  • Gerontology Nurse Practitioner
  • Oak Park Heights, MN
National Provider Identifier
1245744234
Registry record updated Jun 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
5658 Issued in MN
Practice address
5715 Memorial Ave N
Oak Park Heights, MN 55082-1093
Phone
(651) 439-8807
Fax
(651) 439-0232
NPI assigned
Nov 29, 2017
Last updated
Jun 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 5658 MN Primary
Gerontology Nurse Practitioner 363LG0600X 10032-33 WI

Addresses

Primary practice location

5715 Memorial Ave N
Oak Park Heights, MN 55082-1093

Mailing address

3500 American Blvd W Ste 300
Bloomington, MN 55431-4442
Phone (952) 512-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180301002443 MN Practitioner - Nurse Practitioner 9739440058 Reassigns benefits to 2 organizations
I20230802003442 WI Practitioner - Nurse Practitioner 9739440058 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

5715 Memorial Ave N
Oak Park Heights, MN 55082-1093
Phone (651) 439-8807

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5658MNMDSpeech-Language Pathologist
10032-33WIMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Amery Regional Medical Center, Inc. CurrentSince Sep 1, 2023 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Nov 28, 2023 Accepting new patients
Westfields Hospital, Inc CurrentSince Jun 20, 2023 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Nov 28, 2023 Accepting new patients
Group Health, Inc. CurrentSince Jan 2, 2020 Accepting new patients
Group Health, Inc. CurrentSince Jul 10, 2023 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Sep 1, 2023 Accepting new patients
Westfields Hospital, Inc. CurrentSince Jun 20, 2023 Accepting new patients
Group Health, Inc. CurrentSince Jan 2, 2020 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

3500 American Blvd W
Ste 300
Minneapolis, MN 55431
Phone (952) 512-5600

4200 Dahlberg Dr
Ste 300
Minneapolis, MN 55422
Phone (952) 512-5600

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

3366 Oakdale Ave N
Ste 200
Robbinsdale, MN 55422
Phone (763) 287-5000

5715 Memorial Ave N
Stillwater, MN 55082
Phone (514) 398-8076

921 Greeley St S
Stillwater, MN 55082

265 Griffin St E
Amery, WI 54001
Phone (715) 268-0308

535 Hospital Rd
New Richmond, WI 54017
Phone (651) 292-2013

744 E Louisiana St
St Croix Fls, WI 54024
Phone (651) 772-6251

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1511913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781654400000",
    "number": "1245744234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 AMERICAN BLVD W STE 300",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554314442",
            "telephone_number": "952-512-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5715 MEMORIAL AVE N",
            "city": "OAK PARK HEIGHTS",
            "state": "MN",
            "postal_code": "550821093",
            "telephone_number": "651-439-8807",
            "fax_number": "651-439-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "AMANDA",
        "middle_name": "J",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-29",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "5658",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WI",
            "license": "10032-33",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park Heights, MN

Sources for this page

Verify at the official NPI Registry.