Provider Demographics
NPI:1134397813
Name:COULTER, KRISTEN LYNN (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNN
Last Name:COULTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 HILLWIND RD NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5912
Mailing Address - Country:US
Mailing Address - Phone:763-245-7147
Mailing Address - Fax:
Practice Address - Street 1:1831 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1809
Practice Address - Country:US
Practice Address - Phone:612-276-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine