Minnesota Wellcare LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MINNESOTA WELLCARE LLC

Practice address

10519 165TH St W
Lakeville, MN 55044-5722

Phone

(952) 248-2719

NPI assigned

Jan 21, 2022

Organization subpart

No

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

Authorized official

Name

Katie Kocina

Title

Executive Director

Phone

(952) 248-2719

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648512000000",
    "number": "1801548748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10519 165TH ST W",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550445722",
            "telephone_number": "952-248-2719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10519 165TH ST W",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550445722",
            "telephone_number": "952-248-2719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA WELLCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-21",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A",
        "authorized_official_last_name": "KOCINA",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "952-248-2719"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lakeville, MN
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.