KELLY VANVICKLE (NPI# 1013332105) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013332105 |
| Entity Type | Individual |
| Full Name | KELLY VANVICKLE |
| Practice Address |
49725 County 83 Staples MN 56479-5280 |
| Practice Telephone | 2188941515 |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2014-02-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
R147459-6 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
49725 COUNTY 83 |
| City | STAPLES |
| State | MN |
| Zip Code | 56479-5280 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992706709 | Micheal Ginder | Emergency Medicine | 49725 County 83, Staples, MN 56479-5280 | 2005-08-02 |
| 1528670023 | Kelly Rose Taffe | Speech-Language Pathologist | 49725 County 83, Staples, MN 56479-5280 | 2020-08-18 |
| 1700495587 | Madecyn Caroline Franz | Speech-Language Pathologist | 49725 County 83, Staples, MN 56479-5280 | 2020-07-28 |
| 1447869722 | Katherine Alice North | Occupational Therapist | 49725 County 83, Staples, MN 56479-5280 | 2020-07-23 |
| 1528603891 | Paul Ernest Funk | Physical Therapist | 49725 County 83, Staples, MN 56479-5280 | 2019-11-11 |
| 1205480001 | Tyler Kline | Physical Therapist | 49725 County 83, Staples, MN 56479-5280 | 2019-07-30 |
| 1033778238 | Kylie Olson | Speech-Language Pathologist | 49725 County 83, Staples, MN 56479-5280 | 2019-06-11 |
| 1528627783 | Brittany Winter | Speech-Language Pathologist | 49725 County 83, Staples, MN 56479-5280 | 2019-06-11 |
| 1114417284 | Karisa Mueller | Physical Therapist | 49725 County 83, Staples, MN 56479-5280 | 2018-05-15 |
| 1437652807 | Brittany Rose Geditz | Physician Assistant | 49725 County 83, Staples, MN 56479-5280 | 2018-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437758471 | Hpm of Minnesota Pllc | Clinic/Center | 49725 Co Rd 83, Staples, MN 56479 | 2020-10-21 |
| 1639596505 | Barbara Kaneski I | Nurse Practitioner | 49725 Cty 83, Staples, MN 56479 | 2014-03-27 |
| 1932468683 | Lakewood Health System | General Acute Care Hospital | 401 Prairie Ave. N., 49725 Co. Hwy 83, Staples, MN 56479 | 2012-05-15 |
| 1821366683 | Staples Eye Clinic Psc | Optometrist | 922 Us 10 East, Staples, MN 56479 | 2011-12-08 |
| 1831364009 | Lani Longbellaroberts | Pharmacist | 49725 Cty Rd #83, Suite 100, Staples, MN 56479 | 2008-04-28 |
| 1316121858 | Seasons Adult Foster Care | Intermediate Care Facility, Mental Illness | 310 Wisconson Ave Se, Staples, MN 56479 | 2007-12-19 |
| 1881757169 | Peter Joseph Brenny | Dentist | 212 4th St Ne, Staples, MN 56479 | 2006-12-18 |
| 1063571446 | Longbella Drug Inc | Pharmacy | 49725 County Rd 83, Suite 100, Staples, MN 56479 | 2006-12-08 |
| 1932140837 | Lakewood Health System | Pharmacy | 49725 County Road 83, Staples, MN 56479 | 2006-06-10 |
| 1922057421 | St. Cloud Hospital | Clinic/Center | 403 East Prairie Ave, Staples, MN 56479 | 2006-05-10 |
| Find all providers in zip 56479 | ||||
| Taxonomy Code | 363LW0102X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Women's Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013547850 | Lexie Frances Polk | Nurse Practitioner | 3520 N Shore Dr, Wayzata, MN 55391-9360 | 2020-01-21 |
| 1790341865 | Natalie Nicole Johnson | Nurse Practitioner | 9550 Upland Ln N Ste 230, Maple Grove, MN 55369-4484 | 2019-05-14 |
| 1326519646 | Kelsey M Thompson | Nurse Practitioner | 2920 Aldrich Ave S Apt 145, Minneapolis, MN 55408-4275 | 2018-12-13 |
| 1134647274 | Lisa Bergman | Nurse Practitioner | 201 N Victory Dr Ste 211, Mankato, MN 56001-5398 | 2017-09-08 |
| 1528450053 | Stephanie Nielsen | Nurse Practitioner | 1979 Sotlich Rd, Ely, MN 55731-8239 | 2015-02-20 |
| 1366842734 | Meghan Stommes | Nurse Practitioner | 801 Nicollet Mall Ste 400, Minneapolis, MN 55402-2520 | 2014-09-03 |
| 1659710887 | Jessica Williams | Nurse Practitioner | 451 E Saint Germain St Ste 100, Saint Cloud, MN 56304-0761 | 2013-06-20 |
| 1437496700 | Toby Faye Sawyer | Nurse Practitioner | 1001 E Central Entrance Ste 200, Duluth, MN 55811-5525 | 2013-01-07 |
| 1093096927 | Laura J Wilner | Nurse Practitioner | 803 Belsly Blvd # 2, Moorhead, MN 56560-5057 | 2011-09-06 |
| 1861720062 | Linda Marie Christinsen-rengel | Nurse Practitioner | 640 Jackson Street Ms 11101a, Healthpartners Regions Specialty Clinics, Saint Paul, MN 55101 | 2009-11-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.