MRS. KELLY RAE PETERSON (NPI# 1336424027) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336424027 |
| Entity Type | Individual |
| Full Name | MRS. KELLY RAE PETERSON |
| Credential | CRNA |
| Practice Address |
9803 Vagabond Ln N Maple Grove MN 55311-1364 |
| Practice Telephone | 6122421341 |
| Mailing Telephone | 6122421341 |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2012-01-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 88989 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013450907 | Kelly Rose Peterson | Physical Therapist | 1190 Baker St Ste 105, Costa Mesa, CA 92626-4105 | 2016-11-23 |
| 1326437120 | Kelly Leigh Peterson | Nurse Practitioner | 2200 Childrens Way Monroe Carell Jr, Doctor's Office Tower, 7th Floor, Suite 7100, Nashville, TN 37232-0001 | 2015-01-16 |
| 1235413758 | Kelly Suzanne Peterson | Naturopath | 638 Fulton St W Suite B, Grand Rapids, MI 49504 | 2011-10-03 |
| 1710016563 | Kelly Peterson | Counselor | 5240 Ne Elam Young Pkwy Ste 100, Hillsboro, OR 97124 | 2007-03-05 |
| 1558399261 | Kelly B Peterson | Dentist | 5100 Grove St, Ste B, Marysville, WA 98270-4492 | 2006-06-29 |
| 1639787872 | Kelly Peterson | Military Health Care Provider | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-07-14 |
| 1255965208 | Kelly A Peterson | Nurse Practitioner | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-02-28 |
| 1639720014 | Kelly Ann Peterson | Counselor | 20288 Highway 15 N Ste 100, Hutchinson, MN 55350-5685 | 2019-09-26 |
| 1164087730 | Kelly Peterson | Registered Nurse | 410 W 10th Ave, Columbus, OH 43210-1240 | 2019-05-08 |
| 1366923963 | Kelly Peterson | Counselor | 205 Burlington Rd, Bedford, MA 01730-1406 | 2018-08-22 |
| Street Address |
9803 VAGABOND LN N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55311-1364 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609391374 | Deborah Lynn Higgins | Foster Care Agency | 8288 Revelwood Place, Maple Grove, MN 55311 | 2017-08-03 |
| 1013457993 | Trillium Chiropractic & Wellness Pa | Chiropractor | 13700 Reimer Dr Suite 250, Maple Grove, MN 55311 | 2017-02-27 |
| 1720535263 | Fischer Vision PC | Optometrist | 13334 Bass Lake Road North, Maple Grove, MN 55311 | 2016-09-01 |
| 1033571062 | Iman Dadras Konestani | Marriage & Family Therapist | 9325 Garland Lane N Apt 108, Mapple Grove, MN 55311 | 2016-03-29 |
| 1902272685 | Todd Archbold | Social Worker | 18153 80th Pl N, Maple Grove, MN 55311 | 2015-08-17 |
| 1144634395 | Petersen Chiropractic Inc. | Chiropractor | 9505 Blackoaks Ln No., Maple Grove, MN 55311 | 2014-06-16 |
| 1972738276 | Sara Jean Bidler | Marriage & Family Therapist | 7026 E Fish Lake Rd, Maple Grove, MN 55311 | 2009-05-16 |
| 1962670026 | Helminger Chiropractic, P.a. | Chiropractor | 9479 Garland Lane North, Maple Grove, MN 55311 | 2008-02-12 |
| 1457579450 | Cynthia C Cassel | Physician Assistant | 6300 Wedgewood Way, Maple Grove, MN 55311 | 2007-04-23 |
| 1386860732 | Thomas Triden | Chiropractor | 7494 East Fish Lake Road, Maple Grove, MN 55311 | 2007-04-17 |
| Find all providers in zip 55311 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699306100 | Westpacific Westpac Anesthesia-anesthesia Consultants of Minnesot | Nurse Anesthetist, Certified Registered | 9825 Hospital Dr Ste 203, Maple Grove, MN 55369-4772 | 2020-02-03 |
| 1154814580 | Ams Minn Pllc | Nurse Anesthetist, Certified Registered | 13601 80th Cir N Ste 100, Maple Grove, MN 55369-8906 | 2018-06-11 |
| 1487657847 | Jeffrey Merriam | Nurse Anesthetist, Certified Registered | 9645 Grove Cir N Ste 250, Maple Grove, MN 55369 | 2005-05-31 |
| 1871913582 | Ams Maple Grove LLC | Nurse Anesthetist, Certified Registered | 13601 80th Cir N, Ste 100, Maple Grove, MN 55369-8999 | 2014-04-21 |
| 1023358546 | Kayla Jane Runkle | Nurse Anesthetist, Certified Registered | 9875 Hospital Dr, Maple Grove, MN 55369 | 2013-02-20 |
| 1689633919 | Gregory S Mellesmoen | Nurse Anesthetist, Certified Registered | 9645 Grove Cir N Ste 250, Maple Grove, MN 55369 | 2006-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285241364 | Jl Anesthesia, LLC | Nurse Anesthetist, Certified Registered | 13359 Isle Dr Ste 1, Baxter, MN 56425-2223 | 2020-09-23 |
| 1932715679 | Kara Biscobing | Nurse Anesthetist, Certified Registered | M Health Fairview Ummc East Bank 3-307, 500 Harvard Street, Minneapolis, MN 55455 | 2020-09-18 |
| 1952916165 | Benjamin Thomas Garbow | Nurse Anesthetist, Certified Registered | 14700 28th Avenue North, Plymouth, MN 55447 | 2020-09-14 |
| 1689211443 | Siripa Min | Nurse Anesthetist, Certified Registered | 640 Jackson Street Mail Stop 11503, St. Paul, MN 55101 | 2019-11-28 |
| 1952946501 | Wyn Anesthesia, LLC | Nurse Anesthetist, Certified Registered | 991 Sibley Memorial Hwy Ste 202, Saint Paul, MN 55118-5116 | 2019-11-07 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1154894202 | Amy Elizabeth Engstrom | Nurse Anesthetist, Certified Registered | 1411 Premier Dr, Mankato, MN 56001-6076 | 2019-01-10 |
| 1215410311 | Hali Jean Haukos | Nurse Anesthetist, Certified Registered | 640 Jackson St - Mail Stop 13901c, Saint Paul, MN 55101-2502 | 2018-09-13 |
| 1285139865 | Levi Garrett La Porte | Nurse Anesthetist, Certified Registered | Duluth Clinic, 400 East Third Street, Duluth, MN 55805-1951 | 2018-03-27 |
| 1194224303 | Premier Anesthesia Services Inc | Nurse Anesthetist, Certified Registered | 1575 20th St Nw # 205a, Faribault, MN 55021-2930 | 2018-02-03 |
| Find all providers with the same taxonomy | ||||
| City | MAPLE GROVE |
| Zip Code | 55311 |
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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.