Healthcare Provider Details

I. General information

NPI: 1538064639
Provider Name (Legal Business Name): ABYAN KHALIF AHMED APRN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E 25TH ST STE A
MINNEAPOLIS MN
55406-1227
US

IV. Provider business mailing address

6728 YOSEMITE ST
SAINT CLOUD MN
56303-4807
US

V. Phone/Fax

Practice location:
  • Phone: 952-395-5222
  • Fax: 952-395-5333
Mailing address:
  • Phone: 320-291-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13536
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: