Active NPI
Karen Lynn Scully, ATC
- Athletic Trainer
- Maple Grove, MN
National Provider Identifier
1295854685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1432
- Practice address
- 12000 Elm Creek Blvd N
#120
Maple Grove, MN 55369-7073 - Phone
- (763) 420-9960
- NPI assigned
- Mar 28, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1432 | MN | Primary |
Addresses
Primary practice location
12000 Elm Creek Blvd N
#120
Maple Grove, MN 55369-7073
Mailing address
6234 Karston Dr NE
Albertville, MN 55301-8737
Phone (763) 497-0511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1432 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295854685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6234 KARSTON DR NE",
"city": "ALBERTVILLE",
"state": "MN",
"postal_code": "553018737",
"telephone_number": "763-497-0511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12000 ELM CREEK BLVD N",
"address_2": "#120",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553697073",
"telephone_number": "763-420-9960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCULLY",
"first_name": "KAREN",
"middle_name": "LYNN",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "1432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.