Active NPI
Kristin Mary Theisen, RPH
- Pharmacist
- Monticello, MN
National Provider Identifier
1376077792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 116479
- Practice address
- 12099 Blackwood Ave NW
Monticello, MN 55362-3300 - Phone
- (320) 274-3062
- Fax
- (320) 274-6546
- NPI assigned
- Apr 12, 2017
- Last updated
- Apr 12, 2017
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 116479 | MN | Primary |
Addresses
Primary practice location
12099 Blackwood Ave NW
Monticello, MN 55362-3300
Mailing address
12099 Blackwood Ave NW
Monticello, MN 55362-3300
Phone (320) 274-3062
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116479 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491955200000",
"number": "1376077792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12099 BLACKWOOD AVE NW",
"city": "MONTICELLO",
"state": "MN",
"postal_code": "553623300",
"telephone_number": "320-274-3062",
"fax_number": "320-274-6546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12099 BLACKWOOD AVE NW",
"city": "MONTICELLO",
"state": "MN",
"postal_code": "553623300",
"telephone_number": "320-274-3062",
"fax_number": "320-274-6546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEISEN",
"first_name": "KRISTIN",
"middle_name": "MARY",
"name_prefix": "Mrs.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-12",
"last_updated": "2017-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "116479",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monticello, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.