Janelle Elizabeth Kidder, N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CNP 3902 Issued in MN

Practice address

2104 Northdale Blvd NW
Suite 220
Coon Rapids, MN 55433-3028

Phone

(763) 537-6000

Fax

(763) 537-6666

NPI assigned

Jan 2, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jkidder281697@direct.ochin.org

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.

• The Lakes Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Iron River, WI
  • NPI 1811178825
  Medicare reassignment NPD
• The Lakes Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • White Lake, WI
  • NPI 1679983423
  NPD
• The Lakes Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Lakewood, WI
  • NPI 1699778233
  NPD (past)

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435795200000",
    "number": "1437334935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 NORTHDALE BLVD NW",
            "address_2": "SUITE 220",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333028",
            "telephone_number": "763-537-6000",
            "fax_number": "763-537-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 NORTHDALE BLVD NW",
            "address_2": "SUITE 220",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333028",
            "telephone_number": "763-537-6000",
            "fax_number": "763-537-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDDER",
        "first_name": "JANELLE",
        "middle_name": "ELIZABETH",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-02",
        "last_updated": "2015-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.006895",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "CNP 3902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APN LICENSE",
            "identifier": "209006895",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA NP LICENSE",
            "identifier": "CNP 3902",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Michael Ketelsen, DC
• Ami Khan
• Farha Khan, MD
• Mohammed Shaezor Khan, M.D.
• Sia Khang
• Rebecca Kilpatrick, PT
• Jennifer-Eva Bokhui Kim, PHARMACIST
• Jon D. King, CSA
• Jonathan King
• Kingdom Pathways

• Family Nurse Practitioner in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2015; 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.