Individual provider Active NPI

Kendall A Monroe, MS, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1356885644
Registry record updated Oct 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
7364 Issued in MN
Practice address
4027 County Road 25
Minneapolis, MN 55416-2629
Phone
(612) 925-6033
Fax
(612) 925-8496
NPI assigned
Dec 6, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 721673 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F402371-1 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 7364 MN Primary

Addresses

Primary practice location

4027 County Road 25
Minneapolis, MN 55416-2629

Mailing address

4240 Park Glen Rd
St Louis Park, MN 55416-5427
Phone (612) 925-6033

Other practice location 1

1155 Ford Rd Ste B
St Louis Park, MN 55426-1115
Phone (952) 378-1800

Other names 1

  • Kendall A Lyons Former name

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
I20210630002404 MN Practitioner - Nurse Practitioner 6406107796 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Associated Clinic of Psychology IncGroup PAC ID 0749171320, 136 clinicians

Practice addresses (Care Compare)

4027 County Rd
Suite 25
St Louis Park, MN 55416-4119
Phone (612) 925-6033

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
721673NYMDRegistered Nurse
7364MNMDSpeech-Language Pathologist
F402371-1NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medicine Lake Consultation Group,PLLC CurrentSince Apr 16, 2021 Accepting new patients
Associated Clinic of Psychology Inc CurrentSince Apr 16, 2021 Accepting new patients

Locations

1155 Ford Rd
Ste B
St Louis Park, MN 55426
Phone (952) 378-1800

4240 Park Glen Rd
St Louis Park, MN 55416
Phone (612) 925-6033

4027 County Road 25
St Louis Park, MN 55416
Phone (612) 925-6033

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1480982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1356885644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4240 PARK GLEN RD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165427",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4027 COUNTY ROAD 25",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554162629",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1155 Ford Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554261115",
            "country_code": "US",
            "telephone_number": "952-378-1800",
            "fax_number": "952-378-1714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONROE",
        "first_name": "KENDALL",
        "middle_name": "A",
        "credential": "MS, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-06",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "721673",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F402371-1",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "7364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENDALL",
            "last_name": "LYONS",
            "middle_name": "A",
            "credential": "MS, PMHNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.