Kathleen Elizabeth Pengelly, CNP

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

138239-0 Issued in MN

Practice address

762 Transfer Rd Ste 21
Saint Paul, MN 55114-1489

Phone

(651) 659-2900

Fax

(651) 645-7307

NPI assigned

Jan 15, 2019

Last updated

Aug 15, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mental Health Resources, IncGroup PAC ID 0446144992, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

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

• Mental Health Resources, Inc.

  • Community/Behavioral Health Agency
  • Minneapolis, MN
  • NPI 1821276049
  Medicare reassignment Care Compare group NPD
• Mental Health Resources, Inc.

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1790909703
  NPD
• Mental Health Resources, Inc.

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1811175037
  NPD
• Mental Health Resources, Inc.

  • Case Management Agency
  • Burnsville, MN
  • NPI 1376721589
  NPD (past)
• Mental Health Resources, Inc.

  dba MHR

  • Case Management Agency
  • Saint Paul, MN
  • NPI 1538764774
  NPD (past)

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

{
    "created_epoch": "1547510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1760956668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "762 TRANSFER RD STE 21",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141489",
            "telephone_number": "651-955-3397",
            "fax_number": "651-645-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "762 TRANSFER RD STE 21",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141489",
            "telephone_number": "651-659-2900",
            "fax_number": "651-645-7307"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 Highway 13 E Ste 116",
            "address_purpose": "LOCATION",
            "city": "Burnsville",
            "state": "MN",
            "postal_code": "553372877",
            "country_code": "US",
            "telephone_number": "651-681-9366",
            "fax_number": "651-681-9317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15420 Founders Ln",
            "address_purpose": "LOCATION",
            "city": "Apple Valley",
            "state": "MN",
            "postal_code": "551246076",
            "country_code": "US",
            "telephone_number": "651-659-2900",
            "fax_number": "952-431-5842",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENGELLY",
        "first_name": "KATHLEEN",
        "middle_name": "ELIZABETH",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-15",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "6667",
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MN",
            "license": "138239-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tony Alan Pelzel, M.D.
• Michele Pelzer, CRNA
• Joseph Michael Pendal, LADC, LPCC
• Jennifer Pendleton, LMFT
• Virginia Pendleton, RN
• Emily Yoon Penk-Smith, OTR/L, CLT
• Amy Pennig, CNP
• Patricia E Penovich, MD
• Penzi Home Healthcare Agency LLC
• People Diversified Health Care Corp

• Adult Psychiatric/Mental Health Registered Nurse in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Adult Psychiatric/Mental Health Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; 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.