Healthcare Provider Details

I. General information

NPI: 1952289845
Provider Name (Legal Business Name): JILLIAN BESS KANGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 2ND ST SW
ROCHESTER MN
55902-1906
US

IV. Provider business mailing address

4309 1ST ST NW
ROCHESTER MN
55901-3157
US

V. Phone/Fax

Practice location:
  • Phone: 507-255-5123
  • Fax:
Mailing address:
  • Phone: 406-229-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2171093
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7271989
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2507078
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2507078
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: