Provider Demographics
NPI:1902514847
Name:FOSNESS, KRISTEN (ATC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:FOSNESS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 COLFAX AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-2153
Mailing Address - Country:US
Mailing Address - Phone:612-803-9790
Mailing Address - Fax:
Practice Address - Street 1:4200 DAHLBERG DR STE 300
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4841
Practice Address - Country:US
Practice Address - Phone:612-803-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer