Individual provider Active NPI

Gladys Ayiera Ndege, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Plymouth, MN
National Provider Identifier
1659045391
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
8338 Issued in MN
Practice address
1145 Shenandoah LN N
Plymouth, MN 55447-3201
Phone
(763) 464-6462
NPI assigned
Aug 5, 2021
Last updated
May 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 202185 ND
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 10041687 OR
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 8338 MN Primary

Addresses

Primary practice location

1145 Shenandoah LN N
Plymouth, MN 55447-3201

Mailing address

1145 Shenandoah LN N
Plymouth, MN 55447-3201
Phone (763) 464-6462

Other practice location 1

555 SE Mlk Jr Blvd Unit 105
Portland, OR 97214-2595
Phone (602) 430-9646

Other practice location 2

3523 45th St S Ste 100
Fargo, ND 58104-8962
Phone (604) 430-9646

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
202185NDMDPsychiatric/Mental Health Nurse Practitioner
10041687ORMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hopegrows Behavioral Health Psychiatric/Mental Health Current Accepting new patients
Mindful Support Network Limited Current Accepting new patients

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": "1628121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1659045391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 SHENANDOAH LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554473201",
            "telephone_number": "763-464-6462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 SHENANDOAH LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554473201",
            "telephone_number": "763-464-6462"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "555 SE Mlk Jr Blvd Unit 105",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972142595",
            "country_code": "US",
            "telephone_number": "602-430-9646",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3523 45th St S Ste 100",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581048962",
            "country_code": "US",
            "telephone_number": "604-430-9646",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NDEGE",
        "first_name": "GLADYS",
        "middle_name": "AYIERA",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-05",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ND",
            "license": "202185",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "10041687",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "8338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.