1790562130 NPI number — KATHERINE ANN SEARLES DNP, APRN, CPNP-PC

Table of content: KATHERINE ANN SEARLES DNP, APRN, CPNP-PC (NPI 1790562130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790562130 NPI number — KATHERINE ANN SEARLES DNP, APRN, CPNP-PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEARLES
Provider First Name:
KATHERINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP, APRN, CPNP-PC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790562130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2532 QUEBEC AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55426-2546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-269-8406
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15535 34TH AVE N STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55447-2170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-401-8300
Provider Business Practice Location Address Fax Number:
952-401-8242
Provider Enumeration Date:
09/11/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  10753 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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