Katelynn Mae Nyberg, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

13511 Issued in MN

Practice address

12000 Elm Creek Blvd N Ste L70
Maple Grove, MN 55369-7167

Phone

(952) 431-5330

NPI assigned

Mar 30, 2020

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, WI2 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

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Danielle Golden, Crna, PAGroup PAC ID 6305934597, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Danielle Golden, Crna, PA

  dba The Remedy

  • Adult Mental Health Clinic/Center
  • Vadnais Heights, MN
  • NPI 1598954687

  WI

  Medicare reassignment Care Compare group
• Diamond Lake Clinic, P.C.

  • Health Service Clinic/Center
  • Minneapolis, MN
  • NPI 1740669498
  Medicare reassignment

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1639707250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 ELM CREEK BLVD N STE L70",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697167",
            "telephone_number": "524-315-3309",
            "fax_number": "952-431-5334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 ELM CREEK BLVD N STE L70",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697167",
            "telephone_number": "952-431-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYBERG",
        "first_name": "KATELYNN",
        "middle_name": "MAE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-30",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Nugent, MD
• Brooke Kristine Nunemaker, OTR/L
• Juliana Nwokocha, RN,BSN
• Nancy Nyabuti
• Gladys N Nyabwari
• Jessica L Nyholm, M.D.
• Barbara Ellen O'Brien, M.ED., LICSW,LAC,LPC
• Kathleen A O'Brien, LMFT
• Alison O'Meara, APRN-CNP
• Lauren B O'Neill, MD

• Physician Assistant in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; 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.