TYLER STEVEN KETTELKAMP (NPI# 1235372731) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235372731 |
| Entity Type | Individual |
| Full Name | TYLER STEVEN KETTELKAMP |
| Credential | ATC |
| Practice Address |
8559 Edinbrook Pkwy 104 Brooklyn Park MN 55443-3747 |
| Mailing Address |
1745 Cedar Dr New Brighton MN 55112-5246 |
| Practice Telephone | 7634255461 |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2009-04-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
8559 EDINBROOK PKWY 104 |
| City | BROOKLYN PARK |
| State | MN |
| Zip Code | 55443-3747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811923097 | North Memorial Health Care | Clinic/Center | 8559 Edinbrook Pkwy, Suite 100, Brooklyn Park, MN 55443-3728 | 2006-06-23 |
| 1659432664 | Michael Wayne Johnson | Dentist | 8559 Edinbrook Pkwy, Brooklyn Park, MN 55443-3747 | 2006-12-13 |
| 1851450837 | Clarice Ione Hermunslie | Dentist | 8559 Edinbrook Pkwy, Brooklyn Park, MN 55443-3747 | 2006-12-06 |
| 1376602466 | Monica Manoranjin Alley | Dentist | 8559 Edinbrook Pkwy, Brooklyn Park, MN 55443-3747 | 2006-12-06 |
| 1730247321 | Pdg,p.a. | Dentist | 8559 Edinbrook Pkwy, Brooklyn Park, MN 55443-3747 | 2006-12-05 |
| 1306935309 | Rosalynn Torralba | Family Medicine | 8559 Edinbrook Pkwy, Suite 100, Brooklyn Park, MN 55443-3747 | 2006-10-11 |
| 1750478319 | David E Fuglestad | Family Medicine | 8559 Edinbrook Pkwy, Ste 100, Brooklyn Park, MN 55443-3747 | 2006-10-06 |
| 1972690550 | Joseph J Sicora | Family Medicine | 8559 Edinbrook Pkwy, Ste 100, Brooklyn Park, MN 55443-3747 | 2006-10-06 |
| 1649367210 | Ibrahim A Mujir | Family Medicine | 8559 Edinbrook Pkwy, Ste 100, Brooklyn Park, MN 55443-3747 | 2006-10-06 |
| 1992892541 | April L Fitzloff | Physician Assistant | 8559 Edinbrook Pkwy, Ste 100, Brooklyn Park, MN 55443-3747 | 2006-10-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770100521 | El-lyon LLC | Home Health | 5501 88th Crescent North, Brooklyn Park, MN 55443 | 2020-06-28 |
| 1003431628 | Mercy Tasiame Quentin | Home Health | 7310 Unity Lane North, Brooklyn Park, MN 55443 | 2020-06-09 |
| 1386279719 | Andrew Sirlley Dogbe | Nursing Care | 8505 Xerxes Ln N, Brooklyn Park, MN 55443 | 2020-03-05 |
| 1952873630 | Melkezedek Care LLC | Home Health | 8525 N Edinbrook Crossing Suite 204, Brooklyn Park, MN 55443 | 2018-12-19 |
| 1487131330 | Grand St Paul Cvs L L C | Durable Medical Equipment & Medical Supplies | 4400 Oak Grove Parkway, Brooklyn Park, MN 55443 | 2018-07-24 |
| 1063901809 | Patient Centered Home Care Services, LLC. | Registered Nurse | 4127 Sunset Ter N, Brooklyn Park, MN 55443 | 2018-05-08 |
| 1093233942 | Ginni Ali | Registered Nurse | 7527 Yates Lane North, Brooklyn Park, MN 55443 | 2017-08-30 |
| 1437676335 | Uplifted Care Services LLC | Case Management | 3301 84th Ave, Brooklyn Park, MN 55443 | 2017-08-23 |
| 1912447780 | Zillah Mulubisha | Nurse Practitioner | Brooklyn Park Clinic, 7650 Zane Ave N, Minneapolis, MN 55443 | 2017-02-27 |
| 1356898985 | Abdul Kabba | Driver | 79oo Lad Parkway, Brooklyn Park, MN 55443 | 2016-09-01 |
| Find all providers in zip 55443 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861092165 | Jamie Lynn Erickson | Specialist/Technologist | 43628 374th Ln, Aitkin, MN 56431-4027 | 2020-10-27 |
| 1760082044 | Craig Daniel Merten | Specialist/Technologist | 5045 Division Ave # 5575, White Bear Lake, MN 55110-2663 | 2020-10-27 |
| 1154928927 | Heidi Frey | Specialist/Technologist | 4554 Lake Park Ct, Eagan, MN 55122-2515 | 2020-10-05 |
| 1851906887 | Teddy Ray Gildersleeve | Specialist/Technologist | 37320 Oriole Ave, Lindstrom, MN 55045-9109 | 2020-09-15 |
| 1851906697 | Tadd William Berg | Specialist/Technologist | 2415 W 9th St, Duluth, MN 55806-1150 | 2020-09-09 |
| 1952916793 | Megan Marie Hautajarvi | Specialist/Technologist | 2536 Peace Dr, Duluth, MN 55811-2971 | 2020-09-09 |
| 1871108795 | Bryce Mershon Beamish | Specialist/Technologist | 3501 Lowell St, Wayzata, MN 55391-3411 | 2020-09-09 |
| 1043825961 | Kevin Eskuri | Specialist/Technologist | 8090 172nd St W, Lakeville, MN 55044-6206 | 2020-09-09 |
| 1952916876 | Elizabeth Marie Altendorf | Specialist/Technologist | 1621 397th Ave Ne, Stanchfield, MN 55080-3303 | 2020-09-09 |
| 1699380519 | Kourtney Jean Palmi | Specialist/Technologist | 4922 Howard Gnesen Rd, Duluth, MN 55803-2710 | 2020-09-09 |
| Find all providers with the same taxonomy | ||||
| City | BROOKLYN PARK |
| Zip Code | 55443 |
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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.