Provider Demographics
NPI:1518363407
Name:PAULSON, KERRY L (RN,DNP, NP-C,WHNPBC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:L
Last Name:PAULSON
Suffix:
Gender:F
Credentials:RN,DNP, NP-C,WHNPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10903 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-3420
Mailing Address - Country:US
Mailing Address - Phone:952-933-1150
Mailing Address - Fax:
Practice Address - Street 1:10903 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-3420
Practice Address - Country:US
Practice Address - Phone:952-933-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR141245-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health