Kenzie Jackley, PHYSICIAN ASSISTANT
NPI 1396142568ActiveIndividual· Physician Assistant· Edina, MN
Physician Assistant (PHYSICIAN ASSISTANT) in Edina, Minnesota, licensed in MN, with an NPI issued in December 2014. Enrolled in Medicare as practitioner - physician assistant.
Overview
| NPI | 1396142568 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PHYSICIAN ASSISTANT |
| Sole proprietor | No |
| NPI issued | Dec 3, 2014 |
| Last updated in NPPES | Nov 3, 2020 |
| Certified by provider | Nov 3, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | 11821 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (MN) |
|---|
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 148 physician assistants in Edina · All physician assistants in Minnesota