Healthcare Provider Details

I. General information

NPI: 1851774905
Provider Name (Legal Business Name): JESSICA KRAUTH APRN,CNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA WIRTH APRN,CNP,DNP

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

2400 ST FRANCIS DR
BRECKENRIDGE MN
56520-1025
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3700
  • Fax:
Mailing address:
  • Phone: 218-643-0747
  • Fax: 218-643-0748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR44952
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR-187957-3
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR449652
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP 3968
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: