Individual provider Active NPI

Kimberly Kopitzke, RN, CNP

  • Family Nurse Practitioner
  • Edina, MN
National Provider Identifier
1801122379
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP1496 Issued in MN
Practice address
6905 York Ave S
Edina, MN 55435-2517
Phone
(952) 920-0126
NPI assigned
Oct 19, 2009
Last updated
Aug 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CNP1496 MN Primary

Addresses

Primary practice location

6905 York Ave S
Edina, MN 55435-2517

Mailing address

6905 York Ave S
Edina, MN 55435-2517
Phone (952) 920-0126

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100126000854 MN Practitioner - Nurse Practitioner 5294877478 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minuteclinic Diagnostic of Minnesota PAGroup PAC ID 7810289949, 83 clinicians

Practice addresses (Care Compare)

1040 Grand Ave
Saint Paul, MN 55105-3001
Phone (866) 389-2727

1411 Vermillion St
Hastings, MN 55033-2844
Phone (866) 389-2727

1500 109TH Ave NE
Blaine, MN 55449-4670
Phone (866) 389-2727

18275 Kenrick Ave
Lakeville, MN 55044-7306
Phone (866) 389-2727

4848 County Rd
Suite 101
Minnetonka, MN 55345-2635
Phone (866) 389-2727

8900 Hwy 7
Minneapolis, MN 55426-3919
Phone (866) 389-2727

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
CNP1496MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Primary Care Minnesota PLLC Family CurrentSince Apr 1, 2025 Accepting new patients
Minuteclinic Diagnostic of Minnesota, P.a. Family CurrentSince Jan 13, 2018 Accepting new patients

Locations

1010 W Lake St
Minneapolis, MN 55408
Phone (612) 822-1297

1500 109th Ave NE
Minneapolis, MN 55449
Phone (763) 354-1000

6905 York Ave S
Minneapolis, MN 55435
Phone (952) 920-0126

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1255910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1801122379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6905 YORK AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352517",
            "telephone_number": "952-920-0126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6905 YORK AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352517",
            "telephone_number": "952-920-0126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPITZKE",
        "first_name": "KIMBERLY",
        "credential": "RN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-19",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "CNP1496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.