Healthcare Provider Details

I. General information

NPI: 1205748605
Provider Name (Legal Business Name): KRISTA KAYE BJORUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 S RD
MANKATO MN
56001
US

IV. Provider business mailing address

48407 RED ROCK RD
VALLEY SPRINGS SD
57068-6700
US

V. Phone/Fax

Practice location:
  • Phone: 605-496-8037
  • Fax:
Mailing address:
  • Phone: 605-496-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: