NPIMap

Individual provider Active NPI

Kaitlyn Henkelman, D.O.

  • Family Medicine Physician
  • Eden Prairie, MN
National Provider Identifier
1669892964
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
59707 Issued in MN
Practice address
8455 Flying Cloud Dr
Eden Prairie, MN 55344-3974
Phone
(952) 993-7400
Fax
(952) 993-7431
NPI assigned
Apr 24, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 59707 MN Primary

Addresses

Primary practice location

8455 Flying Cloud Dr
Eden Prairie, MN 55344-3974

Mailing address

8170 33Rd Ave S # Ms 21110Q
Bloomington, MN 55425-4516

Other names 1

  • Kaitlyn Kowal Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150929002258 MN Practitioner - Family Practice 8325356090 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

4951 Excelsior Blvd
St Louis Park, MN 55416-3033
Phone (952) 993-1300

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Hospice, Saint Louis Park, MN, CCN 241512
  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
59707MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Family Medicine CurrentSince Sep 12, 2015 Accepting new patients
Park Nicollet Clinic Family Medicine Current Accepting new patients
Park Nicollet Clinic Family Medicine CurrentSince Sep 12, 2015 Accepting new patients

Locations

8455 Flying Cloud Dr
Eden Prairie, MN 55344
Phone (952) 883-9040

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

6600 Excelsior Blvd
Ste 160
St Louis Park, MN 55426
Phone (952) 993-7700

4951 Excelsior Blvd
St Louis Park, MN 55416
Phone (952) 993-1300

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1398297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1669892964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8455 FLYING CLOUD DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443974",
            "telephone_number": "952-993-7400",
            "fax_number": "952-993-7431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENKELMAN",
        "first_name": "KAITLYN",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-24",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "59707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "KOWAL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Eden Prairie, MN

Sources for this page

Verify at the official NPI Registry.