MEDICARE: KATHRYNE JOHANNE BLACKBURN PA-C

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	099600	IA
2	363A00000X	Physician Assistant	13666	MN

General Provider Information

NPI Number	:	1932730157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYNE JOHANNE BLACKBURN PA-C

Provider Business Mailing Address
First Line	:	913 E 26TH ST STE 600
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4515
Country	:	US
Telephone Number	:	612-775-6200
Fax Number	:	612-775-6222

Provider Business Practice Location Address
First Line	:	913 E 26TH ST STE 600
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4515
Country	:	US
Telephone Number	:	612-775-6200
Fax Number	:	612-775-6222

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

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	02/18/2026

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Directions to “ KATHRYNE JOHANNE BLACKBURN PA-C” Practice Location

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