Lisa Renee Thielke, APRN, CNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

10088 Issued in MN

Practice address

1708 1St St S
Willmar, MN 56201-4228

Phone

(218) 999-7750

NPI assigned

Apr 18, 2023

Last updated

Apr 20, 2023By the provider in NPPES

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Modern MojoGroup PAC ID 1456621457, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Appleton Area Health Hospital, Appleton, MN, CCN 241341

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Modern Mojo

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Grand Rapids, MN
  • NPI 1902344591
  Medicare reassignment Care Compare group NPD

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

• Appleton Area Health

  dba Appleton Area Health Services

  • Critical Access Hospital
  • Appleton, MN
  • NPI 1578590626
  Care Compare affiliation

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1699461095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 NW 4TH ST STE A",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557442714",
            "telephone_number": "218-999-7750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 1ST ST S",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014228",
            "telephone_number": "218-999-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIELKE",
        "first_name": "LISA",
        "middle_name": "RENEE",
        "credential": "APRN, CNP, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-18",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "10088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Denese Taylor-Crawford, MD
• Aimee Lyn Tebrake, CNS
• Technical Academies of Minnesota
• Shannon Marie Templer, BSN, RN, CLC
• Kristen Thaden
• Michelle Thomas
• Amanda Marie Thompson, PHARMD BCPS
• Emily Thompson
• Tara Nicole Thompson, PHARMD
• Steven David Thurber, PHD

• Psychiatric/Mental Health Nurse Practitioner in Willmar, MN
• Providers in Willmar, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.