Pediatric and Young Adult Care

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

30822 Issued in MN

Legal business name

PEDIATRIC AND YOUNG ADULT CARE

Practice address

706 South Division St
Northfield, MN 55057-2427

Phone

(507) 645-9534

Fax

(507) 645-8307

NPI assigned

Aug 21, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kristine Gayle Matson, MD

Title

Owner

Phone

(507) 645-9543

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740396910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 SOUTH DIVISION ST",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572427",
            "telephone_number": "507-645-9534",
            "fax_number": "507-645-8307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 SOUTH DIVISION ST",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572427",
            "telephone_number": "507-645-9534",
            "fax_number": "507-645-8307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AND YOUNG ADULT CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MATSON",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_middle_name": "GAYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-645-9543",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "30822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Ozmun, PHARMD
• Laura Jane Page, PH.D., LP
• Nathaniel Page, PHD, LP
• Patricia Richardson MSW, Licsw, LMFT, LTD
• Paula J. Detjen, PLLC
• Nancy Ann Pelegano
• Jeanne Marie Peloquin, PT
• Bonnie Gail Peterson, CRNA
• John Clayton Peterson, PHARMACIST
• Malory Peterson, DDS

• Pediatrics Physician in Northfield, MN
• Providers in Northfield, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.