Active NPI
Carol Lynne Kelly, CNP
- Family Nurse Practitioner
- Bemidji, MN
National Provider Identifier
1780939314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R 89344-0
- Practice address
- 1405 Anne St NW
Bemidji, MN 56601-5113 - Phone
- (218) 368-7795
- Fax
- (218) 444-9252
- NPI assigned
- Jul 19, 2012
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R 89344-0 | MN | Primary |
Addresses
Primary practice location
1405 Anne St NW
Bemidji, MN 56601-5113
Mailing address
PO Box 346
Bemidji, MN 56619-0346
Phone (218) 368-7795
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
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 89344-0 | MN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388102400000",
"number": "1780939314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 346",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566190346",
"telephone_number": "218-368-7795",
"fax_number": "218-444-9252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1405 ANNE ST NW",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566015113",
"telephone_number": "218-368-7795",
"fax_number": "218-444-9252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "CAROL",
"middle_name": "LYNNE",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-19",
"last_updated": "2013-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MN",
"license": "R 89344-0",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bemidji, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.