Individual provider Active NPI

Kathlyn Bergeron, APRN-CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Woodbury, MN
National Provider Identifier
1720420243
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2596 Issued in MN
Practice address
1811 Weir Dr Ste 270
Woodbury, MN 55125-6741
Phone
(651) 714-9646
Fax
(951) 714-9647
NPI assigned
Jul 25, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X G179941 IA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 10970-33 WI
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2596 MN Primary

Addresses

Primary practice location

1811 Weir Dr Ste 270
Woodbury, MN 55125-6741

Mailing address

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789
Phone (651) 628-9566

Other names 1

  • Kathlyn Bellefeuille Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI, IA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20130813000943 MN Practitioner - Certified Clinical Nurse Specialist (CNS) 5395987820 Reassigns benefits to 1 organization
I20210831003075 WI Practitioner - Nurse Practitioner 5395987820 Reassigns benefits to 1 organization
I20251013002404 IA Practitioner - Nurse Practitioner 5395987820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

1811 Weir Dr
Suite 270
Woodbury, MN 55125-6741
Phone 6517149646651714

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2596MNMDMedical Physician Assistant
G179941IAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD CurrentSince Aug 5, 2013 Accepting new patients
Nystrom & Associates Counseling Wi., S.C. CurrentSince May 12, 2021 Accepting new patients
Psychiatric Associates of Iowa, PC CurrentSince Aug 1, 2025 Accepting new patients
Nystrom & Associates Counseling Wi., S.C. CurrentSince May 12, 2021 Accepting new patients
Psychiatric Associates of Iowa, PC CurrentSince Aug 1, 2025 Accepting new patients
Family Support Services Inc. CurrentSince Mar 3, 2024 Accepting new patients

Locations

1105 N Ankeny Blvd
Ankeny, IA 50023
Phone (515) 255-8399

1105 N Ankeny Blvd
Ste 100
Ankeny, IA 50023
Phone (515) 255-8399

3900 Fountains Blvd NE
Ste 203
Cedar Rapids, IA 52411
Phone (319) 727-8297

600 42nd St
Des Moines, IA 50312
Phone (515) 255-8399

2545 N Dodge St
Ste C
Iowa City, IA 52245
Phone (319) 249-0307

673 Westbury Dr
Ste 201
Iowa City, IA 52245
Phone (319) 356-6352

1290 Jordan St
North Liberty, IA 52317
Phone (319) 356-6352

7545 Ashworth Rd
Ste 210
West Des Moines, IA 50266
Phone (515) 644-8224

207 Jefferson Blvd
Big Lake, MN 55309
Phone (763) 367-6080

1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

1811 Weir Dr
Ste 270
Woodbury, MN 55125
Phone (651) 243-6087

2500 E Enterprise Ave
Ste B
Appleton, WI 54913
Phone (920) 416-8577

3703 Oakwood Hills Pkwy
Ste 100
Eau Claire, WI 54701
Phone (534) 444-4562

2501 Hanley Rd
Ste 201
Hudson, WI 54016
Phone (534) 544-5247

201 Main St
Ste 500
La Crosse, WI 54601
Phone (608) 668-4005

1001 Fourier Dr
Ste 200
Madison, WI 53717
Phone (608) 740-2001

Organizations & group practices 6

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": "1374710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756771200000",
    "number": "1720420243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 WEIR DR STE 270",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551256741",
            "telephone_number": "651-714-9646",
            "fax_number": "951-714-9647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGERON",
        "first_name": "KATHLYN",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-25",
        "last_updated": "2025-09-02",
        "certification_date": "2025-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G179941",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "10970-33",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "2596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLYN",
            "last_name": "BELLEFEUILLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.