Healthcare Provider Details

I. General information

NPI: 1497640684
Provider Name (Legal Business Name): THREE BIRDS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 HENNEPIN AVE
MINNEAPOLIS MN
55408-2620
US

IV. Provider business mailing address

3601 KIPLING AVE
ST LOUIS PARK MN
55416-4817
US

V. Phone/Fax

Practice location:
  • Phone: 612-405-9101
  • Fax:
Mailing address:
  • Phone: 612-405-9101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: KRISTA MARIE JOHNSON
Title or Position: MANAGING MEMBER
Credential: APRN
Phone: 612-405-9101