Provider Demographics
NPI:1699766295
Name:SHEFLAND, KELLY A (CNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:SHEFLAND
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 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1290479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1040969OtherPREFERRED ONE
293L4SHOtherBLUE CROSS BLUE SHIELD
166085OtherU-CARE
50A45CEOtherBLUE CROSS BLUE SHIELD
0117264OtherMEDICA HEALTH PLANS
2121654OtherARAZ GROUP/AMERICA'S PPO
HP40007OtherHEALTH PARTNERS
HP40007OtherHEALTH PARTNERS