Healthcare Provider Details

I. General information

NPI: 1982540464
Provider Name (Legal Business Name): RHIANNON KROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RHIANNON THEIS

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 BETHEL DR
SAINT PAUL MN
55112-6902
US

IV. Provider business mailing address

1901 DESOTO ST APT 113
SAINT PAUL MN
55117-2496
US

V. Phone/Fax

Practice location:
  • Phone: 651-638-6400
  • Fax:
Mailing address:
  • Phone: 320-266-7924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: