Active NPI
Kelly A Spray, CNP
- Family Nurse Practitioner
- Pequot Lakes, MN
National Provider Identifier
1487095915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R194132-0
- Practice address
- 4317 W Woodman St
Pequot Lakes, MN 56472-3473 - Phone
- (218) 568-4416
- NPI assigned
- Jul 12, 2013
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R194132-0 | MN | Primary |
Addresses
Primary practice location
4317 W Woodman St
Pequot Lakes, MN 56472-3473
Mailing address
523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 829-2861
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 829-2861
Hospital & facility affiliations
- Good Samaritan Home Health
- Essentia Health St Joseph'S Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R194132-0 | MN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Joseph'S Medical Center | Current | Accepting new patients | |
| Brainerd Medical Center Inc. | Current | Accepting new patients | |
| St. Joseph'S Medical Center | Current | Accepting new patients | |
| St. Joseph'S Medical Center | Current | Accepting new patients | |
| Brainerd Medical Center Inc | Current | Accepting new patients |
Locations
13060 Isle Dr
Brainerd, MN 56425
Phone (218) 454-5920
2024 S 6th St
Brainerd, MN 56401
Phone (218) 828-2880
523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394
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.
-
- General Acute Care Hospital
- Brainerd, MN
- NPI 1568415974
-
- General Practice Physician
- Brainerd, MN
- NPI 1295801777
-
- Clinic Pharmacy
- Staples, MN
- NPI 1972350486
-
- Multi-Specialty Clinic/Center
- Staples, MN
- NPI 1538916101
-
- Primary Care Clinic/Center
- Pine River, MN
- NPI 1649223603
Hospital & facility affiliations 11
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Brainerd, MN
- NPI 1568415974
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Brainerd, MN
- NPI 1740393032
Hospital
-
- Home Health Agency
- Nisswa, MN
- NPI 1225017320
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452816000000",
"number": "1487095915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "523 N 3RD ST",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564013054",
"telephone_number": "218-829-2861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4317 W WOODMAN ST",
"city": "PEQUOT LAKES",
"state": "MN",
"postal_code": "564723473",
"telephone_number": "218-568-4416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPRAY",
"first_name": "KELLY",
"middle_name": "A",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-12",
"last_updated": "2016-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MN",
"license": "R194132-0",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pequot Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.