Individual provider Active NPI

Kelly Elizabeth King, PHD, LP

  • Clinical Psychologist
  • Minneapolis, MN
National Provider Identifier
1679840391
Registry record updated Nov 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP 5429 Issued in MN
Practice address
2512 S 7TH St
Minneapolis, MN 55454-1404
Phone
(612) 626-6777
Fax
(612) 624-1446
NPI assigned
Nov 23, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP 5429 MN Primary

Addresses

Primary practice location

2512 S 7TH St
Minneapolis, MN 55454-1404

Mailing address

420 Delaware St SE
MMC 486
Minneapolis, MN 55455-0341
Phone (612) 624-9796

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111216000577 MN Practitioner - Clinical Psychologist 4880869072 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5429MNMDMental Health Counselor
LP 5429MNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
University of Minnesota Physicians CurrentSince Nov 1, 2011 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Jan 1, 2019 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Health Services CurrentSince Mar 1, 2016 Accepting new patients
Fairview Health Services Current Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Jan 1, 2019 Accepting new patients
University of Minnesota Physicians CurrentSince Nov 1, 2011 Accepting new patients
University of Minnesota Physicians Current Accepting new patients
Cardiothoracic Surgery Clinic of North Ms Past Accepting new patients

Locations

14500 99th Ave N
Maple Grove, MN 55369
Phone (763) 898-1000

2512 S 7th St
Minneapolis, MN 55454
Phone (612) 273-4277

1300 S 2nd St
Ste 180
Minneapolis, MN 55454
Phone (612) 625-1500

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0769

420 Delaware St SE
#486
Minneapolis, MN 55455
Phone (612) 624-8422

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1322006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322006400000",
    "number": "1679840391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "MMC 486",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-624-9796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2512 S 7TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541404",
            "telephone_number": "612-626-6777",
            "fax_number": "612-624-1446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "KELLY",
        "middle_name": "ELIZABETH",
        "credential": "PHD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-23",
        "last_updated": "2011-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP 5429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.