NPIMap

Individual provider Active NPI

Kelly Jean Nadeau Kruger, APRN

  • Nurse Practitioner
  • Maple Grove, MN
National Provider Identifier
1548665896
Registry record updated Apr 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R 165634-3 Issued in MN
Practice address
7840 Vinewood LN N
Maple Grove, MN 55369-7185
Phone
(763) 236-0200
NPI assigned
Oct 29, 2014
Last updated
Apr 19, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R 165634-3 MN Primary

Addresses

Primary practice location

7840 Vinewood LN N
Maple Grove, MN 55369-7185

Mailing address

PO Box 43
Minneapolis, MN 55440-0043
Phone (612) 262-1166

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kkruger42598@excellian.direct.allina.com Direct

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
I20150324001515 MN Practitioner - Nurse Practitioner 4183941594 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R 165634-3MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Current Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System CurrentSince Jun 29, 2015 Accepting new patients
Allina Health System CurrentSince Jun 29, 2015 Accepting new patients
Allina Health System Past Accepting new patients

Locations

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

7840 Vinewood Ln N
Maple Grove, MN 55369
Phone (763) 236-0200

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

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

1021 Bandana Blvd E
Ste 100
Saint Paul, MN 55108
Phone (877) 414-2533

Organizations & group practices 6

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 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1414540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1548665896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554400043",
            "telephone_number": "612-262-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7840 VINEWOOD LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697185",
            "telephone_number": "763-236-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUGER",
        "first_name": "KELLY",
        "middle_name": "JEAN NADEAU",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-29",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R 165634-3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkruger42598@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "7840 Vinewood Ln N",
            "city": "Maple Grove",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553697185",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.