Healthcare Provider Details

I. General information

NPI: 1326806738
Provider Name (Legal Business Name): JOHN MARK MOLSTAD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W COLUMBIA ST
OBERLIN KS
67749-2450
US

IV. Provider business mailing address

PO BOX 268
OBERLIN KS
67749-0268
US

V. Phone/Fax

Practice location:
  • Phone: 785-475-2208
  • Fax:
Mailing address:
  • Phone: 785-475-2208
  • Fax: 785-475-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: