KRISTINE J PEDERSON (NPI# 1730409319) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730409319 |
| Entity Type | Individual |
| Full Name | KRISTINE J PEDERSON |
| Credential | PA-C |
| Practice Address |
610 30th Ave W Alexandria MN 56308-3426 |
| Practice Telephone | 3207635123 |
| Practice Fax Number | 3207635749 |
| Mailing Telephone | 3207635123 |
| Mailing Fax Number | 3207635749 |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2013-11-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 1420 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BCBS | 1730409319 | 01 |
| MN | 1730409319 | 05 |
| Street Address |
610 30TH AVE W |
| City | ALEXANDRIA |
| State | MN |
| Zip Code | 56308-3426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528066651 | Lake Region Eye Center | Optometrist | 610 30th Ave W, Ste 200, Alexandria, MN 56308-3426 | 2005-07-12 |
| 1760005433 | Andrea L Swenson | Registered Nurse | 610 30th Ave W, Alexandria, MN 56308-3426 | 2020-05-28 |
| 1396206959 | Brooke Ann Loeffler | Dietitian, Registered | 610 30th Ave W, Alexandria, MN 56308-3426 | 2019-03-27 |
| 1427515287 | Tara Allison Reichmann | Dietitian, Registered | 610 30th Ave W, Alexandria, MN 56308-3426 | 2019-02-27 |
| 1457816027 | Alomere Health | Dietitian, Registered | 610 30th Ave W, Alexandria, MN 56308 | 2019-02-07 |
| 1306315486 | Maxwell Alan Berscheit | Nurse Practitioner | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-11-18 |
| 1598240376 | Connor William Sacks | Physician Assistant | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-09-27 |
| 1164905659 | Samantha Jean Aabel | Advanced Practice Midwife | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-09-11 |
| 1861970592 | Kelly Jean Mahoney | Physician Assistant | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-08-03 |
| 1205365830 | Skyler Holte Dahlseng | Internal Medicine | 610 30th Ave W, Alexandria, MN 56308-3426 | 2017-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871104836 | Center for Pain Management Ambulatory Surgery, Ltd | Pain Medicine | 804 23rd Street South, Sartell, MN 56308 | 2020-08-13 |
| 1548815590 | Ritajo Ellenberger | Licensed Practical Nurse | 220 Oak Street North, Alexandria, MN 56308 | 2019-08-06 |
| 1346808714 | Vance Thompson Vision Surgery Center Alexandria, Prof LLC | Clinic/Center | 2600 Jefferson St, Alexandria, MN 56308 | 2019-05-31 |
| 1811452048 | Little Falls Eye Care Center Pa | Optometrist | 2306 S. Broadway Str. Suite 12, Alexandria, MN 56308 | 2019-02-01 |
| 1184167199 | Jennifer Lynn Craig | Technician | 2307 East Golf Course Rd, Alexandria, MN 56308 | 2016-11-22 |
| 1548712219 | Shelby Elisha Johnsrud | Chiropractor | 303 West 22nd Ave, Ste 100, Alexandria, MN 56308 | 2016-10-28 |
| 1811347867 | Dustin Matthew Ditch | Dentist | 510 22nd Ave E Ste 702, Alexandria, MN 56308 | 2016-06-20 |
| 1639538051 | West Central Chiropractic & Wellness, LLC | Chiropractor | 123 3rd Ave. E, Suite 100, Alexandria, MN 56308 | 2016-02-12 |
| 1659736221 | Amanda Jean Dahlseng | Registered Nurse | 809 Elm Street, Suite 1200, Alexandria, MN 56308 | 2015-12-23 |
| 1518358886 | Benjamin G Wenzel | Marriage & Family Therapist | 512 30th Ave S, Ste 100, Alexandria, MN 56308 | 2015-02-09 |
| Find all providers in zip 56308 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962015750 | Hannah Wallen | Physician Assistant | 8101 Hinson Farm Rd Ste 501, Alexandria, VA 22306-3403 | 2020-08-31 |
| 1811509953 | Trenton Todd Thelen | Physician Assistant | 2000 Huntington Ave Apt 1201, Alexandria, VA 22303-1715 | 2020-08-19 |
| 1497310056 | Melissa Marie Spooner | Physician Assistant | 277 S Washington St Ste 100, Alexandria, VA 22314-3678 | 2019-05-08 |
| 1568025880 | Rola Mourad | Physician Assistant | 7508 Snowpea Ct Unit F, Alexandria, VA 22306-2258 | 2019-04-22 |
| 1114491248 | Skylar Alexa Lisse | Physician Assistant | 426 S Columbus St, Alexandria, VA 22314-3606 | 2019-01-11 |
| 1891151494 | Michelle Malzahn Shelton | Physician Assistant | Red River Cardiology, 201 4th Street, Ste. 4a, Alexandria, LA 71301-8421 | 2016-01-12 |
| 1285004051 | Virginia Minehart Cinzano | Physician Assistant | 6355 Walker Ln Ste 401, Alexandria, VA 22310-3250 | 2015-10-05 |
| 1457791956 | Elise Marie Nash Ferre | Physician Assistant | 6161 Edsall Rd, Apt 203, Alexandria, VA 22304-4166 | 2013-06-28 |
| 1114266954 | Stella M Meusch | Physician Assistant | 4230 Seminary Rd, Alexandria, VA 22304 | 2013-02-13 |
| 1396080800 | Laura Provenzano | Physician Assistant | 3117 Duke St, Alexandria, VA 22314-4518 | 2012-12-10 |
| Find all providers in ALEXANDRIA | ||||
| City | ALEXANDRIA |
| Zip Code | 56308 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.