| Doctor Name: | KATHERINE BALCOM |
| NPI Number: | 1033530167 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 2019 |
| Business Practice Address: | 6363 France Ave S Suite 212 Edina, MN - 554352129 |
| Business Phone Number: | 6513121700 |
| Business Fax Number: | 6513121570 |
| Mailing Address: | 1055 Westgate Dr, Suite 190 SAINT PAUL |
| State: | MN |
| Postal Code: | 551141065 |
| Phone Number: | 6513121505 |
| Fax Number: | 6516411720 |
| NPI Enumeration Date: | 12/16/2013 |
| NPI Last Update Date: | 12/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 2019 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |