Provider Demographics
NPI:1124636063
Name:LEBLANC, KELLIE LYNN (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:LYNN
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:700 DECATUR AVE NORTH
Mailing Address - Street 2:STE 109
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427
Mailing Address - Country:US
Mailing Address - Phone:612-682-4912
Mailing Address - Fax:612-682-4914
Practice Address - Street 1:700 DECATUR AVE NORTH
Practice Address - Street 2:STE 109
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427
Practice Address - Country:US
Practice Address - Phone:612-682-4912
Practice Address - Fax:612-682-4914
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN7557363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily