Active NPI
Kristen Alexa Burnett, PSY.D., LP
- Clinical Psychologist
- Plymouth, MN
National Provider Identifier
1699823237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4651
- Practice address
- 11505 36TH Ave N
Plymouth, MN 55441-2304 - Phone
- (763) 509-3818
- Fax
- (763) 559-0149
- NPI assigned
- Jan 8, 2007
- Last updated
- Jul 8, 2007
- 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 Psychologist | 103TC0700X | 4651 | MN | Primary |
Addresses
Primary practice location
11505 36TH Ave N
Plymouth, MN 55441-2304
Mailing address
11505 36TH Ave N
Plymouth, MN 55441-2304
Phone (763) 509-3818
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Aug 25, 2015 through Aug 25, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4651 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699823237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11505 36TH AVE N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554412304",
"telephone_number": "763-509-3818",
"fax_number": "763-559-0149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11505 36TH AVE N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554412304",
"telephone_number": "763-509-3818",
"fax_number": "763-559-0149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURNETT",
"first_name": "KRISTEN",
"middle_name": "ALEXA",
"credential": "PSY.D., LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "4651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.