Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Grant Gullickson, PA-C

Individual provider Physician Assistant · NPI 1770279408

Mr. Grant Gullickson, PA-C is a Physician Assistant in New Brighton, Minnesota. Qualified in 2022, 4 years ago. Practices with Nystrom and Associates Ltd, a 617-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Minnesota.

Years since qualifying
4
Licensed in
MN
In the registry since
2023
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789
Phone: (651) 628-9566
Fax: (651) 628-0411
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 14410 (MN)

Record details

NPI number1770279408
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedApril 14, 2023
Last updated in NPPESApril 14, 2023
Certification dateApril 14, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Nystrom And Associates Ltd — 617 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in New Brighton