Kelly Witucki, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15652 Issued in MN

Practice address

1575 Beam Ave
Maplewood, MN 55109-1126

Phone

(651) 232-7348

NPI assigned

Sep 6, 2025

Sex

Female

Sole proprietor

No

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

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

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Care Consultants PAGroup PAC ID 5496640161, 105 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• M Health Fairview St John'S Hospital Hospital, Maplewood, MN, CCN 240210
• M Health Fairview Woodwinds Hospital Hospital, Woodbury, MN, CCN 240213

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Emergency Care Consultants, PA

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1669422788
  Medicare reassignment Care Compare group NPD (past)

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

• Healtheast St. John'S Hospital

  • General Acute Care Hospital
  • Maplewood, MN
  • NPI 1447218482
  Care Compare affiliation
• Healtheast Woodwinds Hospital

  • General Acute Care Hospital
  • Woodbury, MN
  • NPI 1356309322
  Care Compare affiliation

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

{
    "created_epoch": "1757116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769040000000",
    "number": "1649150822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2829 UNIVERSITY AVE SE STE 730",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554143279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 BEAM AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091126",
            "telephone_number": "651-232-7348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITUCKI",
        "first_name": "KELLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-06",
        "last_updated": "2026-01-22",
        "certification_date": "2026-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "15652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter B Wilton, MD
• Damian Alexander Winkelmann, DDS
• Keith Matthew Wirth
• Peggy Ann Wiseman, REGISTERED NURSE
• Jaena J Wisniewski, MD
• Jessica Wong, PHARMD
• Aubrey Lynn Workman, MA, R-DMT
• Kristi Kay Worrell, OTR-L
• Emma Worthley, MA
• Colleen Woyach, MA, CF-SLP

• Physician Assistant in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2026; 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.