Individual provider Active NPI

Jennifer Lynn Hibbard-Kaidi, NP-C

  • Family Nurse Practitioner
  • Plymouth, MN
National Provider Identifier
1588077317
Registry record updated Jul 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5501 Issued in MN
Practice address
4140 County Road 101 N
Plymouth, MN 55446-2308
Phone
(763) 478-4612
NPI assigned
Jun 10, 2014
Last updated
Jul 30, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X COA.15969-NP OH
Family Nurse Practitioner 363LF0000X 5501 MN Primary

Addresses

Primary practice location

4140 County Road 101 N
Plymouth, MN 55446-2308

Mailing address

4140 County Road 101 N
Plymouth, MN 55446-2308
Phone (763) 478-4612

Other identifiers 1

IdentifierTypeStateIssuer
0105015MedicaidOH

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180228001052 MN Practitioner - Nurse Practitioner 3971729088 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Wright State University Boonshoft School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minuteclinic Diagnostic of Minnesota PAGroup PAC ID 7810289949, 83 clinicians

Practice addresses (Care Compare)

1411 Vermillion St
Hastings, MN 55033-2844
Phone (866) 389-2727

1500 109TH Ave NE
Blaine, MN 55449-4670
Phone (866) 389-2727

15051 Galaxie Ave
Apple Valley, MN 55124-6987
Phone (866) 389-2727

2730 County Rd E E
White Bear Lake, MN 55110-4963
Phone (866) 389-2727

4140 County Rd 101
Plymouth, MN 55446-2308
Phone (866) 389-2727

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5501MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Primary Care Minnesota PLLC Family CurrentSince Apr 1, 2025 Accepting new patients
Minuteclinic Diagnostic of Minnesota, P.a. Family CurrentSince Mar 10, 2018 Accepting new patients

Locations

1010 W Lake St
Minneapolis, MN 55408
Phone (612) 822-1297

1500 109th Ave NE
Minneapolis, MN 55449
Phone (763) 354-1000

4140 County Road 101 N
Plymouth, MN 55446
Phone (763) 478-4612

600 Central Ave E
Saint Michael, MN 55376
Phone (605) 651-3024

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690675200000",
    "number": "1588077317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4140 COUNTY ROAD 101 N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554462308",
            "telephone_number": "763-478-4612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4140 COUNTY ROAD 101 N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554462308",
            "telephone_number": "763-478-4612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIBBARD-KAIDI",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-10",
        "last_updated": "2023-07-30",
        "certification_date": "2023-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.15969-NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "5501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0105015",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.