Individual
KRISTINE J PEDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
610 30TH AVE W, ALEXANDRIA, MN 56308-3426
(320) 763-5123
(320) 763-5749
Mailing address
610 30TH AVE W, ALEXANDRIA, MN 56308-3426
(320) 763-5123
(320) 763-5749
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1420
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730409319
BCBS
MN
05
—
1730409319
—
MN
Enumeration date
06/07/2010
Last updated
05/20/2022
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