Healthcare Provider Details

I. General information

NPI: 1730002270
Provider Name (Legal Business Name): KATIE THI CLARKSON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 W 66TH ST
RICHFIELD MN
55423-2203
US

IV. Provider business mailing address

790 W 66TH ST
RICHFIELD MN
55423-2203
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-6963
  • Fax:
Mailing address:
  • Phone: 612-873-6963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14330
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: