Healthcare Provider Details

I. General information

NPI: 1982474599
Provider Name (Legal Business Name): BRENNA LYNN MCKELVEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS BRENNA LYNN OLSON

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11269 JEFFERSON HWY N
CHAMPLIN MN
55316-3123
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-0600
  • Fax: 763-236-0790
Mailing address:
  • Phone: 612-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14772
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: