| The Good Clinic | |
|
4712 Excelsior Blvd St Louis Park MN 55416-3008 | |
| (844) 383-8689 | |
| Not Available |
| Full Name | The Good Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 4712 Excelsior Blvd, St Louis Park, Minnesota |
| Authorized Official Name and Position | Kevin Lee Smith (CHIEF NURSE PRACTITIONER OFFICER) |
| Authorized Official Contact | 7636395327 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Good Clinic 1660 Highway 100 S Ste 432 St Louis Park MN 55416-1533 Ph: () - | The Good Clinic 4712 Excelsior Blvd St Louis Park MN 55416-3008 Ph: (844) 383-8689 |
| NPI Number | 1003423252 |
|---|---|
| Provider Enumeration Date | 09/30/2020 |
| Last Update Date | 01/14/2022 |
| Medicare PECOS PAC ID | 0941616742 |
|---|---|
| Medicare Enrollment ID | O20210302002351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003423252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kevin Lee Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679531024 PECOS PAC ID: 7810980851 Enrollment ID: I20040406000920 |
| Provider Name | Kerry A Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477504058 PECOS PAC ID: 6709882194 Enrollment ID: I20061006000426 |
| Provider Name | Anne Margaret Guiral |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306096342 PECOS PAC ID: 2163584897 Enrollment ID: I20081215000345 |
| Provider Name | Paul Linson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891029872 PECOS PAC ID: 8729121363 Enrollment ID: I20100204000851 |
| Provider Name | Kimberly D Yung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710265368 PECOS PAC ID: 1254504061 Enrollment ID: I20111021000557 |
| Provider Name | Lisa T Tieu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265869606 PECOS PAC ID: 1254567191 Enrollment ID: I20131122001209 |
| Provider Name | Ashley J Thersleff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720456577 PECOS PAC ID: 0648589226 Enrollment ID: I20151021002712 |
| Provider Name | Whitney S Sarnstrom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063885440 PECOS PAC ID: 8527360627 Enrollment ID: I20160106002203 |
| Provider Name | Angela M Laughlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245778612 PECOS PAC ID: 8325323223 Enrollment ID: I20170315002007 |
| Provider Name | Donald Dunow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013047463 PECOS PAC ID: 0143458158 Enrollment ID: I20180620000658 |
| Provider Name | Jessica M Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578058038 PECOS PAC ID: 7911255948 Enrollment ID: I20180807002361 |
| Provider Name | Sarah R Tupper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861977472 PECOS PAC ID: 5496008310 Enrollment ID: I20181023002044 |
| Provider Name | Hannah M Christian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841761160 PECOS PAC ID: 9931448842 Enrollment ID: I20190311001479 |
| Provider Name | Brett A Jahnke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952915282 PECOS PAC ID: 4789094426 Enrollment ID: I20201107000126 |
| Provider Name | Francine Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336532514 PECOS PAC ID: 6305154253 Enrollment ID: I20220511002565 |
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