Provider Demographics
NPI:1972668846
Name:ADAMS, KATHRYN R (CPNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:R
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:R
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:200 UNIVERSITY AVE E
Mailing Address - Street 2:GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2507
Mailing Address - Country:US
Mailing Address - Phone:651-291-2848
Mailing Address - Fax:
Practice Address - Street 1:200 UNIVERSITY AVE E
Practice Address - Street 2:GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2507
Practice Address - Country:US
Practice Address - Phone:651-291-2848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR130820-6363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1030454OtherPREFERREDONE
IA0585398Medicaid
12-01624OtherMEDICA - CHOICE
171945OtherUCARE
WI43953500Medicaid
MT0439647Medicaid
203A6JOOtherBLUE CROSS BLUE SHIELD
MN106602100Medicaid
HP34896OtherHEALTHPARTNERS
500001842Medicare ID - Type Unspecified
WI43953500Medicaid
MT0439647Medicaid