NPI 1740915115 · live from the CMS NPI Registry
Kylie Engebretson, PA-C
Physician Assistant in Fargo, ND. National Provider Identifier 1740915115, active.
NPI record
| NPI | 1740915115 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 4110 51st Ave S, Fargo, ND 58104 |
| Practice phone | 701-364-3100 |
| Mailing address | 1702 University Dr S, Fargo, ND 58103 |
| Enumerated | July 20, 2022 |
| Last updated | July 20, 2022 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant primary | 363A00000X | PAC0952 (ND) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.