Individual provider Active NPI

Jenna Therese Kallemeyn, PA-C

  • Physician Assistant
  • Fairmont, MN
National Provider Identifier
1295437929
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15136 Issued in MN
Practice address
1950 Center Creek Dr
Fairmont, MN 56031-3428
Phone
(320) 224-5761
NPI assigned
Mar 20, 2023
Last updated
Sep 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 15136 MN Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1950 Center Creek Dr
Fairmont, MN 56031-3428

Mailing address

1950 Center Creek Dr
Fairmont, MN 56031-3428

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
I20241209002698 MN Practitioner - Physician Assistant 8022544402 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
May accept Medicare assignment
Group practices
United Hospital District IncGroup PAC ID 6204158884, 50 clinicians

Practice addresses (Care Compare)

1950 Ctr Creek Dr
Fairmont, MN 56031-3428
Phone (507) 238-1287

515 S Moore St
Blue Earth, MN 56013-2158
Phone (507) 526-7388

PO Box
Suite 160
Blue Earth, MN 56013-0160

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15136MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
United Hospital District Inc. PastSince Oct 31, 2021 Accepting new patients

Organizations & group practices 2

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": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758240000000",
    "number": "1295437929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 CENTER CREEK DR",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560313428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 CENTER CREEK DR",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560313428",
            "telephone_number": "320-224-5761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLEMEYN",
        "first_name": "JENNA",
        "middle_name": "THERESE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-20",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "15136",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairmont, MN

Sources for this page

Verify at the official NPI Registry.