Kyle Allan Kackman, APRN, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

3028 Issued in MN

Practice address

1 Veterans Dr
Minneapolis, MN 55417-2309

Phone

(763) 725-2000

NPI assigned

Sep 27, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Central Minnesota Anesthesia Providers, PA

  • Certified Registered Nurse Anesthetist
  • Becker, MN
  • NPI 1881689974

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD

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

{
    "created_epoch": "1727395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1366260549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4944 EMERSON AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554195334",
            "telephone_number": "763-222-7517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VETERANS DR",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554172309",
            "telephone_number": "763-725-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACKMAN",
        "first_name": "KYLE",
        "middle_name": "ALLAN",
        "credential": "APRN, CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-27",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "3028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terrance J Kaase, CRNA
• Lilian D Kaba, PMHNP-BC
• David Kabuye
• Stone Hamabwe Kabwe, CNP, APRN, FNP-C
• Sandra M Kacher, LICSW
• Christopher J Kaczmarczyk, DO
• Tesia Gabrielle Kaczmarek, RD
• Ayesha Kadir, MD
• Fatima Ahmed Kadir
• Noor Abdullahi Kadir

• Certified Registered Nurse Anesthetist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Certified Registered Nurse Anesthetist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.