Healthcare Provider Details

I. General information

NPI: 1396277232
Provider Name (Legal Business Name): KADRA ABDUL HOSH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 W 84TH ST
BLOOMINGTON MN
55437-1373
US

IV. Provider business mailing address

1305 UNIVERSITY AVE W
SAINT PAUL MN
55104-4178
US

V. Phone/Fax

Practice location:
  • Phone: 952-395-5222
  • Fax:
Mailing address:
  • Phone: 651-206-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14213
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: