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General NPI Number Information
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NPI Number | 1679390652
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Entity Type | Individual
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Provider Name | KIMBERLIE LARSON RN, BSN
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Gender | Female
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 2101 ELM ST N
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City | FARGO
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State | ND
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Zip | 58102-2417
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Country | US
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Telephone | 218-234-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 ELM ST N
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City | FARGO
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State | ND
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Zip | 58102-2417
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Country | US
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Telephone | 218-234-6600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | R38487
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 202733
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License Number State | ND
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