Healthcare Provider Details

I. General information

NPI: 1245977198
Provider Name (Legal Business Name): KALEIGH REBECCA NELLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13603 80TH CIR N
MAPLE GROVE MN
55369-8961
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW
NEW BRIGHTON MN
55112-1786
US

V. Phone/Fax

Practice location:
  • Phone: 763-274-3120
  • Fax: 763-274-3121
Mailing address:
  • Phone: 763-274-3120
  • Fax: 763-274-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number83442
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: