Provider Demographics
NPI:1417188350
Name:SKILLINGSTAD, KALINA (PA-C)
Entity Type:Individual
Prefix:
First Name:KALINA
Middle Name:
Last Name:SKILLINGSTAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 NORTHWAY DR
Mailing Address - Street 2:STE 103
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1262
Mailing Address - Country:US
Mailing Address - Phone:605-940-9018
Mailing Address - Fax:
Practice Address - Street 1:101 DEHLER DR
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4407
Practice Address - Country:US
Practice Address - Phone:320-253-3512
Practice Address - Fax:320-253-1037
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1298363AM0700X
MN10621363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical