Individual
CASEY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
2620 EAGAN WOODS DR, EAGAN, MN 55121
(651) 968-5200
Mailing address
1272 RANDOLPH AVE, SAINT PAUL, MN 55105-2954
(651) 357-5802
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5920
MN
Other
Enumeration date
06/29/2018
Last updated
08/29/2020
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