Kelly Jean Grossman, CNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

12166 Issued in MN

Practice address

2303 Wycliff St Ste W210
Saint Paul, MN 55114-1272

Phone

(612) 424-0434

Fax

(877) 905-7069

NPI assigned

Oct 9, 2024

Last updated

Oct 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, NE2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Group practices

Susan Borden PsychGroup PAC ID 4688011612, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

Practice roles

Locations

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.

• Susan Borden Psych

  dba Center for Conscious Alchemy

  • Psychiatric/Mental Health Nurse Practitioner
  • Saint Paul, MN
  • NPI 1780313478
  Medicare reassignment Care Compare group NPD
• Great Plains Mental Health Associates LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Omaha, NE
  • NPI 1831614064
  Medicare reassignment

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

{
    "created_epoch": "1728432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1629897160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6204 CASCADE PASS",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553179475",
            "telephone_number": "913-645-7599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2303 WYCLIFF ST STE W210",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141272",
            "telephone_number": "612-424-0434",
            "fax_number": "877-905-7069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6204 Cascade Pass",
            "address_purpose": "LOCATION",
            "city": "Chanhassen",
            "state": "MN",
            "postal_code": "553179475",
            "country_code": "US",
            "telephone_number": "913-645-7599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROSSMAN",
        "first_name": "KELLY",
        "middle_name": "JEAN",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-09",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "12166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Allen Gross, RN, CRNA
• Merry Catherine Gross, CRNA
• Robert T Grossett, MD
• Rebecca Grossman-Kahn, MD
• Amy Christine Grossman, LICSW
• Leslie Anne Grossmann Brown, LCSW
• Todd Aldor Grossmann, DDS
• Lucas Allen Grossoehme
• Raksmey Grotte, LP
• Group Health Plan Inc (HealthPartners Specialty Center-435 Phalen)

• Psychiatric/Mental Health Nurse Practitioner in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.

Verify at the official NPI Registry.