Healthcare Provider Details

I. General information

NPI: 1922646983
Provider Name (Legal Business Name): KATHRYN PALKKI ANDERSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 SCHUTTA RD
SHOREVIEW MN
55126-4947
US

IV. Provider business mailing address

5600 SCHUTTA RD
SHOREVIEW MN
55126-4947
US

V. Phone/Fax

Practice location:
  • Phone: 801-234-0132
  • Fax:
Mailing address:
  • Phone: 801-234-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14403
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: