Kristen McCullough, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

R0975355 Issued in MN

Practice address

606 24TH Ave S
Suite 700
Minneapolis, MN 55454-1455

Phone

(612) 672-2450

NPI assigned

Feb 28, 2006

Sex

Female

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

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.

• Fairview Express Care

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  NPD
• Fairview Express Care

  • General Practice Physician
  • Edina, MN
  • NPI 1831707207
  NPD
• Fairview Clinics

  • Primary Care Clinic/Center
  • Saint Paul, MN
  • NPI 1396552147
  NPD (past)

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334188800000",
    "number": "1396711313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 24TH AVE S",
            "address_2": "SUITE 700",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541455",
            "telephone_number": "612-672-2450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 24TH AVE S",
            "address_2": "SUITE 700",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541455",
            "telephone_number": "612-672-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "KRISTEN",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2012-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "MN",
            "license": "R0975355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Noel McCullough-Cain, BCC
• Margy Elise McCullough-Hicks, M.D.
• Betsy Jean McCullough, PSY.D., L.P.C.
• Brian Patrick McCullough, LPCC
• John Jeffrey McCullough, MD
• Sarah Lindsey McCullough, CNM, FNP-C
• Martha L McCusker, MD
• Debra Jean McDermott, RN, CNP
• Mark T McDermott, OD
• Olive McDermott

• Advanced Practice Midwife in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Advanced Practice Midwife in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.