Healthcare Provider Details

I. General information

NPI: 1144049321
Provider Name (Legal Business Name): JESSICA MARIE PERSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 02/15/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

2123 ALLISON LN
WEST FARGO ND
58078-8495
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3732
  • Fax:
Mailing address:
  • Phone: 701-740-6228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14270510-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR49389
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202959
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14270510-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: