Healthcare Provider Details

I. General information

NPI: 1801710587
Provider Name (Legal Business Name): KELLIE J OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W 66TH ST
RICHFIELD MN
55423
US

IV. Provider business mailing address

7126 4TH AVE S
RICHFIELD MN
55423-3242
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-6963
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2497407
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: