Provider Demographics
NPI:1972684942
Name:PICKEN, KRISTI K (RN,MS,CNS)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:K
Last Name:PICKEN
Suffix:
Gender:F
Credentials:RN,MS,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 COUNTY ROAD 42 WEST.
Mailing Address - Street 2:CASHMAN CENTER
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:952-224-8990
Mailing Address - Fax:952-224-8991
Practice Address - Street 1:2100 COUNTY ROAD 42 WEST.
Practice Address - Street 2:CASHMAN CENTER
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-224-8990
Practice Address - Fax:952-224-8991
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR12998942084P0800X
MNR-129989-4364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN506814200Medicaid
MN506814200Medicaid
890000082Medicare ID - Type Unspecified