MEDICARE: EMMA KRAFT PA-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	15515	MN

General Provider Information

NPI Number	:	1366132532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA KRAFT PA-S

Provider Business Mailing Address
First Line	:	2800 COUNTY ROAD 42 W
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-6933
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 COUNTY ROAD 42 W
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-6933
Country	:	US
Telephone Number	:	763-201-8191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	06/25/2026

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