Healthcare Provider Details

I. General information

NPI: 1740180488
Provider Name (Legal Business Name): COURTNEY KJELDGAARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2026
Last Update Date: 11/06/2026
Certification Date: 10/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BROADWAY N
FARGO ND
58102-4421
US

IV. Provider business mailing address

806 PARK DR S
FARGO ND
58103-5336
US

V. Phone/Fax

Practice location:
  • Phone: 970-302-2685
  • Fax:
Mailing address:
  • Phone: 970-302-2685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number206313
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: