Katie McClellan Wigdahl, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1209 Issued in MN

Practice address

10900 Wayzata Blvd Ste 215
Minnetonka, MN 55305-5505

Phone

(952) 500-0350

NPI assigned

Oct 3, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• One Stop Medical Center

  • Clinic/Center
  • Casselberry, FL
  • NPI 1336335066
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643500800000",
    "number": "1538310990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4848 COUNTY ROAD 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553452635",
            "telephone_number": "952-401-3830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10900 WAYZATA BLVD STE 215",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055505",
            "telephone_number": "952-500-0350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4848 County Road 101",
            "address_purpose": "LOCATION",
            "city": "Minnetonka",
            "state": "MN",
            "postal_code": "553452635",
            "country_code": "US",
            "telephone_number": "952-401-3830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIGDAHL",
        "first_name": "KATIE",
        "middle_name": "MCCLELLAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-03",
        "last_updated": "2022-01-30",
        "certification_date": "2022-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "10512",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "1209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalia Wiatros, DO
• Christie Ann Wick, LMFT
• Beth M. Wicklund, M.D.
• Jacquelyn K. Wiersma, PH. D.
• Michelle Lynn Wiersma, MS, CCC-SLP
• Sandra Wiita
• Jamie Wilcox, L.AC
• Wildflower Wellness Counseling
• Meredith Wray Wilkerson, FNP
• Kyle James Wilkes, DDS

• Physician Assistant in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.