Provider Demographics
NPI:1720049695
Name:KEMPER, KRISTEN L (CPNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:KEMPER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 CENTRE POINTS DRIVE
Mailing Address - Street 2:35 121A
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2109
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:2525 CHICAGO AVENUE SOUTH
Practice Address - Street 2:CHILDRENS SPECIALTY CLINIC CLEFT AND CRANIOFACIAL
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-813-6777
Practice Address - Fax:612-813-6953
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1379772363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN507469000Medicaid