Provider Demographics
NPI:1639100282
Name:KEARIN, JAMES P (PA -C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:KEARIN
Suffix:
Gender:M
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 1:3001 METRO DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4506
Mailing Address - Country:US
Mailing Address - Phone:952-814-6600
Mailing Address - Fax:
Practice Address - Street 1:2800 CHICAGO AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1318
Practice Address - Country:US
Practice Address - Phone:952-814-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8930363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN554197200Medicaid
MN970000019Medicare ID - Type Unspecified
MN554197200Medicaid