Active NPI
Corey Koyamatsu, APRN, AGCNS-BC
- Clinical Nurse Specialist
- Minneapolis, MN
National Provider Identifier
1679379960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Nurse Specialist
- License
- 642
- Practice address
- 500 Harvard St SE
Minneapolis, MN 55455-0363 - Phone
- (612) 273-8890
- NPI assigned
- Feb 19, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Nurse Specialist | 364S00000X | 642 | MN | Primary |
Addresses
Primary practice location
500 Harvard St SE
Minneapolis, MN 55455-0363
Mailing address
420 Delaware St. SE
Mayo B355
Minneapolis, MN 55455-0363
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 642 | MN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739923200000",
"number": "1679379960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 DELAWARE ST. SE",
"address_2": "MAYO B355",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 HARVARD ST SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550363",
"telephone_number": "612-273-8890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOYAMATSU",
"first_name": "COREY",
"credential": "APRN, AGCNS-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-02-19",
"last_updated": "2025-02-19",
"certification_date": "2025-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "364S00000X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist",
"state": "MN",
"license": "642",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.