Provider Demographics
NPI:1427155159
Name:WHORTON, MARY KAY (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:WHORTON
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3420 W SAINT GERMAIN ST
Mailing Address - Street 2:APT 212
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-6501
Mailing Address - Country:US
Mailing Address - Phone:320-230-0266
Mailing Address - Fax:
Practice Address - Street 1:4801 VETERANS DR
Practice Address - Street 2:BLDG 1
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2015
Practice Address - Country:US
Practice Address - Phone:320-252-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALPA-330363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical