Healthcare Provider Details

I. General information

NPI: 1841933827
Provider Name (Legal Business Name): MEGAN KLINKHAMMER APRN, C-PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 45TH ST S STE B
FARGO ND
58104-8970
US

IV. Provider business mailing address

3441 45TH ST S STE B
FARGO ND
58104-8970
US

V. Phone/Fax

Practice location:
  • Phone: 701-541-1254
  • Fax:
Mailing address:
  • Phone: 701-552-6573
  • Fax: 701-203-2772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR37768
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: