Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelli Ann Polum, PHYSICIANASSISTANT

Individual provider Medical Physician Assistant · NPI 1184275794

Kelli Ann Polum, PHYSICIANASSISTANT is a Physician Assistant in Winona, Minnesota. Qualified in 2019, 7 years ago. Practices with Gundersen Lutheran Medical Center Inc, a 896-clinician group and accepts Medicare assignment. Licensed in Minnesota and Wisconsin.

Years since qualifying
7
Licensed in
MN, WI
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

1122 W Highway 61
Winona, MN 55987-1957
Phone: (608) 782-7300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 13360 (MN)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 4850 (WI)

Record details

NPI number1184275794
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedSeptember 25, 2019
Last updated in NPPESJuly 21, 2020
Certification dateJuly 21, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Gundersen Lutheran Medical Center Inc — 896 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Winona