NPIMap

Individual provider Active NPI

Kathleen Powers Graham, NP-C

  • Adult Health Nurse Practitioner
  • Plymouth, MN
National Provider Identifier
1407100357
Registry record updated Apr 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
A0712144 Issued in MN
Practice address
15700 37TH Ave N Ste 300
Plymouth, MN 55446-3661
Phone
(612) 871-1145
NPI assigned
Oct 30, 2012
Last updated
Apr 24, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X G0712013 MN
Adult Health Nurse Practitioner 363LA2200X A0712144 MN Primary

Addresses

Primary practice location

15700 37TH Ave N Ste 300
Plymouth, MN 55446-3661

Mailing address

1973 Sloan PL
Maplewood, MN 55117-2084
Phone (612) 871-1145

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121214000114 MN Practitioner - Nurse Practitioner 4486806619 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mngi Digestive Health PAGroup PAC ID 8123016557, 276 clinicians

Practice addresses (Care Compare)

10150 Niagara LN N
Suite 210
Maple Grove, MN 55369-7588
Phone (612) 871-1145

1185 Town Centre Dr
Suite 200
Eagan, MN 55123-1343
Phone (612) 871-1145

15700 37TH Ave N
Plymouth, MN 55446-3399
Phone (612) 871-1145

15700 37TH Ave N
Suite 300
Plymouth, MN 55446-3661
Phone (612) 871-1145

3001 Broadway St NE
B700
Minneapolis, MN 55413-2195
Phone (612) 871-1145

3588 Arcade St
Suite 110
Vadnais Heights, MN 55127-7135
Phone (612) 871-1145

800 E 28TH St
Minneapolis, MN 55407-3723
Phone (612) 863-4633

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1374MNMDMental Health Counselor
A0712144MNMDAdult Health Nurse Practitioner
G0712013MNMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Apr 1, 2024 Accepting new patients
Allina Health System CurrentSince Apr 1, 2024 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System Current Accepting new patients
Mngi Digestive Health, P.a. CurrentSince Nov 12, 2012 Accepting new patients
Allina Health System CurrentSince Apr 1, 2024 Accepting new patients
Courage Center Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

1175 Nininger Rd
Hastings, MN 55033
Phone (651) 404-1000

1285 Nininger Rd
Hastings, MN 55033
Phone (651) 480-4200

1880 N Frontage Rd
Hastings, MN 55033
Phone (651) 438-1800

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

15700 37th Ave N
Plymouth, MN 55446
Phone (763) 577-0008

15700 37th Ave N
Ste 300
Plymouth, MN 55446
Phone (612) 870-5438

280 Smith Ave N
Ste 700
Saint Paul, MN 55102
Phone (651) 241-3535

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: kathleen.grahamnp.p1@direct.mngastro.nextgenshare.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524528000000",
    "number": "1407100357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1973 SLOAN PL",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551172084",
            "telephone_number": "612-871-1145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15700 37TH AVE N STE 300",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463661",
            "telephone_number": "612-871-1145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "KATHLEEN",
        "middle_name": "POWERS",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-30",
        "last_updated": "2018-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "G0712013",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "A0712144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.