Individual
MRS. KATHERINE ROSE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5109 36TH AVE N, CRYSTAL, MN 55422
(763) 587-7999
(763) 587-7989
Mailing address
5109 36TH AVE N, CRYSTAL, MN 55422
(763) 587-7999
(763) 587-7989
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14744
MN
Other
Enumeration date
12/05/2023
Last updated
03/31/2025
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