Provider Demographics
NPI:1508199423
Name:IHRY, KELLY R (CNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:IHRY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:5700 BOTTINEAU BLVD
Mailing Address - Street 2:#210
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429
Mailing Address - Country:US
Mailing Address - Phone:763-587-7000
Mailing Address - Fax:763-587-7015
Practice Address - Street 1:9825 HOSPITAL DR
Practice Address - Street 2:#205
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-587-7000
Practice Address - Fax:763-587-7015
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2015-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR174987-8363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner