Jennifer Debra Kish, GNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

CNP0023 Issued in MN

Practice address

8307 Kimball Dr
Eden Prairie, MN 55347-2127

Phone

(612) 324-9111

NPI assigned

Apr 8, 2008

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630108800000",
    "number": "1932372224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1157 JUBERT TRL",
            "city": "MEDINA",
            "state": "MN",
            "postal_code": "553403707",
            "telephone_number": "952-412-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8307 KIMBALL DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553472127",
            "telephone_number": "612-324-9111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 W 66th St",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554352111",
            "country_code": "US",
            "telephone_number": "952-836-3637",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7701 York Street",
            "address_2": "Ste. 100",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554355543",
            "country_code": "US",
            "telephone_number": "125-790-5976",
            "fax_number": "612-493-4221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISH",
        "first_name": "JENNIFER",
        "middle_name": "DEBRA",
        "credential": "GNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-08",
        "last_updated": "2021-08-28",
        "certification_date": "2021-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "R1722659",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "CNP0023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Korina Klaysmat, DPT
• Lisa Kleingarn, MA

• Gerontology Nurse Practitioner in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Gerontology Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.