Individual provider Active NPI

Kelsey Kohorst Solberg

  • Acute Care Nurse Practitioner
  • Duluth, MN
National Provider Identifier
1376216184
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
2373625 Issued in MN
Practice address
407 E 3Rd St
Duluth, MN 55805-1950
Phone
(218) 786-4000
NPI assigned
Jul 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 2373625 MN Primary

Addresses

Primary practice location

407 E 3Rd St
Duluth, MN 55805-1950

Mailing address

SSB-6
400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Other names 1

  • Kelsey Sullivan 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
I20210916000828 MN Practitioner - Nurse Practitioner 9739586868 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Medical CenterGroup PAC ID 6901706357, 91 clinicians

Practice addresses (Care Compare)

402 E 2ND St
Duluth, MN 55805-1906
Phone (218) 786-3443

Hospital & facility affiliations

  • Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002
  • Essentia Health Duluth Hospital, Duluth, MN, CCN 240019

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2373625MNMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic, LTD. CurrentSince Sep 7, 2021 Accepting new patients
St. Mary'S Medical Center CurrentSince Oct 1, 2024 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
St Marys Medical Center Current Accepting new patients
The Duluth Clinic, LTD CurrentSince Sep 7, 2021 Accepting new patients

Locations

407 E 3rd St
Duluth, MN 55805
Phone (218) 786-4357

400 E 3rd St
#6
Duluth, MN 55805
Phone (320) 360-1676

402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1627430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1376216184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SSB-6",
            "address_2": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051950",
            "telephone_number": "218-786-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLBERG",
        "first_name": "KELSEY",
        "middle_name": "KOHORST",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-28",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MN",
            "license": "2373625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "SULLIVAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.