Jennifer H Kyllo, MD

Primary specialty

Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X

License

39114 Issued in MN

Practice address

Children'S Specialty Clinic-Diabetes/Endocrinology-STPL
347 North Smith Avenue
St Paul, MN 55102

Phone

(651) 220-6818

Fax

(651) 220-6064

NPI assigned

Aug 16, 2005

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

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Childrens Health Care

  • Pediatrics Physician
  • Minneapolis, MN
  • NPI 1932208808
  Medicare reassignment NPD
• Shriners Hospitals for Children

  • Rehabilitation Clinic/Center
  • Woodbury, MN
  • NPI 1285250977
  Medicare reassignment NPD
• Childrens Health Care

  • Hearing Aid Equipment
  • Minneapolis, MN
  • NPI 1790827905
  NPD
• Childrens Health Care

  • Children's Hospital
  • Minneapolis, MN
  • NPI 1881793750
  NPD
• Shriners Hospitals for Children

  • Clinic/Center
  • Aiea, HI
  • NPI 1568299857
  NPD
• Shriners Hospitals for Children

  • Orthopaedic Surgery Physician
  • Lexington, KY
  • NPI 1700223559
  NPD (past)

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346284800000",
    "number": "1679565774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CHILDREN'S HEALTH CARE",
            "address_2": "2910 CENTRE POINTE DRIVE, 35-121A",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "651-855-2327",
            "fax_number": "651-855-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CHILDREN'S SPECIALTY CLINIC-DIABETES/ENDOCRINOLOGY-STPL",
            "address_2": "347 NORTH SMITH AVENUE",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55102",
            "telephone_number": "651-220-6818",
            "fax_number": "651-220-6064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KYLLO",
        "first_name": "JENNIFER",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-16",
        "last_updated": "2012-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "MN",
            "license": "39114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "328214700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Kwiatkowski, MA, LPCC
• Shaun W Kwosek, MD
• Allan Kyariga
• Kathryn A Kyler, CRNA
• Natalie Kyllo-Peters, PT
• Marit Kyllo, L.A.M.F.T.
• La Familia Guidance Center
• Vanesa Concepcion La Torre Martinez
• Lab Drugs & Medical-Trans-Supplies LLC
• Thomas Laberge, MD

• Pediatric Endocrinology Physician in St Paul, MN
• Providers in St Paul, MN by specialty
• Pediatric Endocrinology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.