Provider Demographics
NPI:1689385932
Name:WOLF, KRISTY ANN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:ANN
Last Name:WOLF
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11695 42ND ST SE
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55319-9813
Mailing Address - Country:US
Mailing Address - Phone:651-341-0299
Mailing Address - Fax:320-238-7470
Practice Address - Street 1:8085 WAYZATA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426-1461
Practice Address - Country:US
Practice Address - Phone:612-296-3800
Practice Address - Fax:612-259-7665
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9791363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health