Healthcare Provider Details

I. General information

NPI: 1023929742
Provider Name (Legal Business Name): KATHERINE MARIE CLAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 KENWOOD AVE
DULUTH MN
55811-4199
US

IV. Provider business mailing address

66100 186TH PL
JACOBSON MN
55752-4837
US

V. Phone/Fax

Practice location:
  • Phone: 218-723-6000
  • Fax:
Mailing address:
  • Phone: 605-610-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2243221
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: