Nicole Lynn Larson, DNP, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1563 Issued in MN

Practice address

149 Thompson Ave E Ste 150
West St Paul, MN 55118-3238

Phone

(651) 450-0860

Fax

(651) 450-0759

NPI assigned

Mar 27, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Nicole Lynn Lynch Former name

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

Medicare enrollment (NPD)

Enrolled

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.

• Associated Clinic of Psychology Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • St Louis Park, MN
  • NPI 1588741292
  Medicare reassignment NPD
• Family Support Services Inc.

  dba Sagent Behavioral Health

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD (past)

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666310400000",
    "number": "1720048317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4240 PARK GLEN RD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165427",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 THOMPSON AVE E STE 150",
            "city": "WEST ST PAUL",
            "state": "MN",
            "postal_code": "551183238",
            "telephone_number": "651-450-0860",
            "fax_number": "651-450-0759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "NICOLE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DNP, APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-27",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MN",
            "license": "1574425",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "1563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "LYNCH",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lori Suzanne Kurszewski, ATC
• Emily Anne Kvasnicka Friedrichsen, MD
• Antony William Lakey, BCO
• Marc Landes, PHARMD
• Matthew Larson, DPT
• Nicholas Lawson, M.D.
• Ruth M Lehman Wiens, MD
• Alice C Lehman, MS, RN, PMHCNS-BC
• Kimberly Lorene Lester, MSW, LICSW
• Lifelong Dental Care

• Psychiatric/Mental Health Nurse Practitioner in West St Paul, MN
• Providers in West St Paul, 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 Oct 21, 2022; 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.