Provider Demographics
NPI:1538208806
Name:CARR, KRISTEN M (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:CARR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2829 UNIVERSITY DR S STE 101
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6050
Mailing Address - Country:US
Mailing Address - Phone:701-478-4722
Mailing Address - Fax:701-893-9057
Practice Address - Street 1:2829 UNIVERSITY DR S STE 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6050
Practice Address - Country:US
Practice Address - Phone:701-478-4722
Practice Address - Fax:701-893-9057
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDPAC0364363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant