Active NPI
Katelyn Niederkorn
- Other Technician
- Moorhead, MN
National Provider Identifier
1710655873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 1530 1St Ave N Ste 150
Moorhead, MN 56560-2278 - Phone
- (763) 228-8148
- NPI assigned
- Sep 2, 2021
- 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 |
|---|---|---|---|---|
| Other Technician | 247200000X | Primary |
Addresses
Primary practice location
1530 1St Ave N Ste 150
Moorhead, MN 56560-2278
Mailing address
PO Box 58
Hendrum, MN 56550-0058
Phone (763) 228-8148
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648425600000",
"number": "1710655873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 58",
"city": "HENDRUM",
"state": "MN",
"postal_code": "565500058",
"telephone_number": "763-228-8148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1530 1ST AVE N STE 150",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565602278",
"telephone_number": "763-228-8148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIEDERKORN",
"first_name": "KATELYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-02",
"last_updated": "2022-03-28",
"certification_date": "2021-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.