Provider Demographics
NPI:1437602828
Name:EGAN, KRISTIN M (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:EGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15655 37TH AVE N STE 100
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4003
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-587-7701
Practice Address - Street 1:15655 37TH AVE N STE 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-4003
Practice Address - Country:US
Practice Address - Phone:763-587-7900
Practice Address - Fax:763-587-7701
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN12253363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant