| New Kingdom Pediatrics Llc | |
|
6452 City West Pkwy Eden Prairie MN 55344-3245 | |
| (952) 999-0333 | |
| Not Available |
| Full Name | New Kingdom Pediatrics Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6452 City West Pkwy, Eden Prairie, Minnesota |
| Authorized Official Name and Position | Robert Zajac (CEO) |
| Authorized Official Contact | 9524124229 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Kingdom Pediatrics Llc 6452 City West Pkwy Eden Prairie MN 55344-3245 Ph: (952) 999-0333 | New Kingdom Pediatrics Llc 6452 City West Pkwy Eden Prairie MN 55344-3245 Ph: (952) 999-0333 |
| NPI Number | 1760816045 |
|---|---|
| Provider Enumeration Date | 08/22/2013 |
| Last Update Date | 08/22/2013 |
| Medicare PECOS PAC ID | 7315266806 |
|---|---|
| Medicare Enrollment ID | O20150505001812 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760816045 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 44503 (Minnesota) | Primary |
| Provider Name | Robert J Zajac |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1578551636 PECOS PAC ID: 7113831447 Enrollment ID: I20031119000428 |
| Provider Name | James J Martineau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205927084 PECOS PAC ID: 8921006487 Enrollment ID: I20061116000169 |
| Provider Name | Laurel M Wills |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1962416313 PECOS PAC ID: 3577613041 Enrollment ID: I20090604000465 |
| Provider Name | Jessica A Fashant-peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609109982 PECOS PAC ID: 9335275130 Enrollment ID: I20100331000800 |
| Provider Name | Katie L Seremet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144534140 PECOS PAC ID: 5698964070 Enrollment ID: I20150506001577 |
| Provider Name | Carol J Eggersgluess |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740631415 PECOS PAC ID: 0749576114 Enrollment ID: I20160912000248 |
| Provider Name | Stephanie Augustin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447772934 PECOS PAC ID: 3678846938 Enrollment ID: I20170907003114 |
| Provider Name | Cynthia Lee Voigt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801304696 PECOS PAC ID: 1254682131 Enrollment ID: I20180918000243 |
| Provider Name | Quincee Lynn Macgibbon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285295626 PECOS PAC ID: 1759610405 Enrollment ID: I20190906000035 |
| Provider Name | Catharine Davis Reed |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1942273867 PECOS PAC ID: 7113259532 Enrollment ID: I20191104001835 |
| Provider Name | Callie Sahr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164052718 PECOS PAC ID: 0749618759 Enrollment ID: I20200325000077 |
| Provider Name | Amy Pedersen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407466436 PECOS PAC ID: 9638581853 Enrollment ID: I20201211002784 |
| Provider Name | Amanda L King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558962399 PECOS PAC ID: 3274946892 Enrollment ID: I20201228001935 |
| Provider Name | Bridget Ann Pikkarainen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215504899 PECOS PAC ID: 2264836352 Enrollment ID: I20210811003667 |
| Provider Name | Sheldon Seemann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952065013 PECOS PAC ID: 2668867797 Enrollment ID: I20220328000767 |
| Provider Name | Sharon Elizabeth Buesing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093383077 PECOS PAC ID: 8325417272 Enrollment ID: I20221215001095 |
| Provider Name | Kristofer Bristol |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134855034 PECOS PAC ID: 9335519909 Enrollment ID: I20221226000162 |
| Provider Name | Alissa Joy Boekhout |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639804214 PECOS PAC ID: 6901276294 Enrollment ID: I20230103000910 |
| Provider Name | Jaime Louise Reinke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669152419 PECOS PAC ID: 1850755315 Enrollment ID: I20230915003601 |
| Provider Name | Jenni L. S. West |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821870957 PECOS PAC ID: 3173970803 Enrollment ID: I20231116003132 |
| Provider Name | Marisa Lynn Pender |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710454517 PECOS PAC ID: 7012366115 Enrollment ID: I20231214002932 |
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