Individual
KAITLYN MELLESMOEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7400 FRANCE AVE S STE 100, EDINA, MN 55435-4738
(763) 537-6000
Mailing address
2104 NORTHDALE BLVD NW STE 220, COON RAPIDS, MN 55433-3046
(763) 537-6000
(763) 537-6666
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13559
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1166361
NCCPA
—
01
—
13559
MN BOARD OF MEDICAL PRACTICE PA LICENSURE
MN
Enumeration date
08/20/2021
Last updated
11/19/2025
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