MS. KIM NAN KELLEY OTRL
NPI 1679631899
Specialist in Minnetonka, MN
About Ms. Kim Nan Kelley Otrl NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MS. KIM NAN KELLEY OTRL (NPI 1679631899) is an individual specialist in Minnetonka, Minnesota, licensed in Minnesota (102295) and active in the NPI registry since December 2006.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ms. Kim Nan Kelley Otrl is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kim Kelley reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Victoria, MN 55386
- Reassigned Medicare billing, Minnesota enrollment
- 26 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MINNETONKA, MN 55305
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kim Kelley's NPI number?
The NPI number for Kim Kelley is 1679631899. It was assigned to this individual provider in the NPPES registry on December 4, 2006.
Where is Kim Kelley located?
Kim Kelley practices at 3395 Plymouth Rd, Minnetonka, MN 55305. The listed phone number is (952) 939-0396.
What is Kim Kelley's specialty?
The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.
Is Kim Kelley enrolled in Medicare?
Yes. Kim Kelley is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kim Kelley's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kim Kelley reassigns Medicare benefits to Kid Talk Inc (Victoria, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kim Kelley's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kim Kelley was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Ms. Kim Nan Kelley, OTRL · NPI 1679631899
Specialist provider in Minnetonka, Minnesota. Individual provider, active in the CMS NPPES registry since December 4, 2006.
## Identity
- **NPI:** 1679631899 (Entity type: Individual)
- **Enumerated:** December 4, 2006
- **Primary specialty:** Specialist · taxonomy 174400000X
- **State license:** 102295 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 3395 PLYMOUTH RD, Minnetonka, MN 55305-3765
- **Phone:** (952) 939-0396 · **Fax:** (952) 548-8760
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** Kid Talk Inc (NPI 1245315027, Victoria, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 8, 2007
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Source: [NPI Profile](https://npiprofile.com/npi/1679631899) · Data from the CMS NPPES public registry.