Provider Demographics
NPI:1639975964
Name:MATTSON, KELLY LEE (DNP, APRN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:MATTSON
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 10TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-2843
Mailing Address - Country:US
Mailing Address - Phone:218-851-4105
Mailing Address - Fax:
Practice Address - Street 1:50 CENTRACARE DR
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-2100
Practice Address - Country:US
Practice Address - Phone:320-732-2131
Practice Address - Fax:320-732-6913
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily