Provider Demographics
NPI:1285605592
Name:WINTER, KELLY (CNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WINTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRA CARE CIRCLE
Mailing Address - Street 2:CENTRA CARE CLINIC WOMENS CHILDRENS
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:
Practice Address - Street 1:1900 CENTRA CARE CIRCLE
Practice Address - Street 2:CENTRA CARE CLINIC WOMENS CHILDRENS
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR128866-9363LW0102X
MNR1288669363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1045420OtherPREFERRED ONE
HP56438OtherHEALTH PARTNERS
135486OtherUCARE
07-04519OtherMEDICA
2384629OtherAMERICA'S PPO (ARAZ)
MN434G5WIOtherBCBS MN
Q59537Medicare UPIN