Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Katherine Rose Clark, PA-C

Individual provider Physician Assistant · NPI 1003683509

Mrs. Katherine Rose Clark, PA-C is a Physician Assistant in Crystal, Minnesota. Graduated from Touro Un Col of Osteopathic Medicine, Henderson in 2023, 3 years ago. Practices with North Clinic PA, a 49-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
3
Trained at
Touro Un Col of Osteopathic Medicine, Henderson
Licensed in
MN
In the registry since
2023
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

5109 36th Ave N
Crystal, MN 55422
Phone: (763) 587-7999
Fax: (763) 587-7989
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 9825 Hospital Dr Ste 300, Maple Grove, MN 55369-4768 — (763) 587-7999

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 14744 (MN)

Record details

NPI number1003683509
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedDecember 5, 2023
Last updated in NPPESMarch 31, 2025
Certification dateMarch 26, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolTOURO UN COL OF OSTEOPATHIC MEDICINE, HENDERSON
Graduated 2023 (3 years in practice)
Group practice North Clinic Pa — 49 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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