Provider Demographics
NPI:1760824874
Name:CARLSON, KRISTINA RAE (RN, MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:RAE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 N. JACKSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56087
Mailing Address - Country:US
Mailing Address - Phone:877-412-7575
Mailing Address - Fax:507-723-6447
Practice Address - Street 1:625 N. JACKSON AVENUE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MN
Practice Address - Zip Code:56087
Practice Address - Country:US
Practice Address - Phone:877-412-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR1748934OtherRN