Provider Demographics
NPI:1518287481
Name:KLINGAMAN, JONATHAN FRANKLIN (PMHNP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:FRANKLIN
Last Name:KLINGAMAN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 HIGHWAY 73
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-9452
Mailing Address - Country:US
Mailing Address - Phone:218-565-6200
Mailing Address - Fax:
Practice Address - Street 1:1111 HIGHWAY 73
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767-9452
Practice Address - Country:US
Practice Address - Phone:218-565-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 174297-2363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health