Individual
MRS. KATHLEEN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3400 S BROADWAY, MINOT, ND 58701-7420
(701) 418-2600
(701) 418-1090
Mailing address
3400 S BROADWAY, MINOT, ND 58701-7420
(701) 418-2600
(701) 418-2600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0139
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13123
BLUE CROSS/BLUE SHIELD
ND
Enumeration date
01/18/2006
Last updated
12/14/2025
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