1154927879 NPI number — ALLISON RENAE KEY MSM, PA-C

Table of content: ALLISON RENAE KEY MSM, PA-C (NPI 1154927879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154927879 NPI number — ALLISON RENAE KEY MSM, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEY
Provider First Name:
ALLISON
Provider Middle Name:
RENAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSM, PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EIMERS
Provider Other First Name:
ALLISON
Provider Other Middle Name:
RENAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154927879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4240 PARK GLEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416-5427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-925-6033
Provider Business Mailing Address Fax Number:
612-925-8496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6160 SUMMIT DR N STE 450
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN CENTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55430-2121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-503-8560
Provider Business Practice Location Address Fax Number:
763-503-8563
Provider Enumeration Date:
12/08/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA13518 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 14631 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PA13518 . This is a "TEXAS PHYSICIAN ASSISTANT BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 14631 . This is a "MN BOARD OF MEDICAL PRACTICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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