Provider Demographics
NPI:1457818270
Name:BADENHORST, KRISTIN S (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:S
Last Name:BADENHORST
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 1:43843 STATE HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:RUSHFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55971-5173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 KANSAS ST NW
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:MN
Practice Address - Zip Code:55965-8904
Practice Address - Country:US
Practice Address - Phone:507-765-5324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant