Provider Demographics
NPI:1992836076
Name:JOHANSEN, KARN J (PA-C)
Entity type:Individual
Prefix:
First Name:KARN
Middle Name:J
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 YORK AVE S STE 130
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4510
Mailing Address - Country:US
Mailing Address - Phone:612-730-2237
Mailing Address - Fax:888-809-6033
Practice Address - Street 1:7101 YORK AVE S STE 130
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4510
Practice Address - Country:US
Practice Address - Phone:612-730-2237
Practice Address - Fax:888-809-6033
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001286363A00000X
MN12967363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP06813Medicare UPIN