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General NPI Number Information
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NPI Number | 1285605592
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Entity Type | Individual
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Provider Name | KELLY WINTER CNP
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Gender | Female
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 1900 CENTRA CARE CIRCLE CENTRA CARE CLINIC WOMENS CHILDRENS
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City | ST CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone | 320-654-3630
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 CENTRA CARE CIRCLE CENTRA CARE CLINIC WOMENS CHILDRENS
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City | ST CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone | 320-654-3630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | R128866-9
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | R1288669
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License Number State | MN
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