Individual
MISS KATE JEAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 ALTON AVE SE, NEW PRAGUE, MN 56071-5507
(952) 758-7228
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11412
MN
363AM0700X
Medical Physician Assistant
11412
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11412
MN STATE LICENSE
MN
Enumeration date
07/01/2013
Last updated
03/17/2018
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