Active NPI
Kristen D. Bricko, RD LD
- Registered Dietitian
- Saint Cloud, MN
National Provider Identifier
1457753873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 3426
- Practice address
- 1200 6TH Ave N
Centracare Clinic
Saint Cloud, MN 56303-2735 - Phone
- (320) 252-3342
- NPI assigned
- Sep 17, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 3426 | MN | Primary |
Addresses
Primary practice location
1200 6TH Ave N
Centracare Clinic
Saint Cloud, MN 56303-2735
Mailing address
1200 6TH Ave N
Centracare Clinic
Saint Cloud, MN 56303-2735
Phone (320) 252-3342
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150417000835 | MN | Practitioner - Registered Dietitian Or Nutrition Professional | 9931427259 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Support Services Inc. | Current | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients |
Locations
9245 Quantrelle Ave NE
Otsego, MN 55330
Phone (763) 308-8619
1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718
Organizations & group practices 3
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.
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-
- Multi-Specialty Clinic/Center
- Saint Cloud, MN
- NPI 1225030844
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410912000000",
"number": "1457753873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 6TH AVE N",
"address_2": "CENTRACARE CLINIC",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563032735",
"telephone_number": "320-252-3342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 6TH AVE N",
"address_2": "CENTRACARE CLINIC",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563032735",
"telephone_number": "320-252-3342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRICKO",
"first_name": "KRISTEN",
"middle_name": "D.",
"name_prefix": "Ms.",
"credential": "RD LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-17",
"last_updated": "2014-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "3426",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.