Healthcare Provider Details

I. General information

NPI: 1427828904
Provider Name (Legal Business Name): MICHELLE NICHOLE KASPER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 3RD ST SE
KASSON MN
55944-2943
US

IV. Provider business mailing address

603 3RD ST SE
KASSON MN
55944-2943
US

V. Phone/Fax

Practice location:
  • Phone: 507-910-4609
  • Fax: 877-940-3378
Mailing address:
  • Phone: 507-910-4609
  • Fax: 877-940-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11077
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: