NIKOLE LEE KOEHN (NPI# 1033563325) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033563325 |
| Entity Type | Individual |
| Full Name | NIKOLE LEE KOEHN |
| Credential | MATRG, ATC |
| Practice Address |
2301 25th St S Fargo ND 58103 |
| Mailing Address |
4551 47th Ave. South Apt. 103 Fargo ND 58103 |
| Practice Telephone | 7014176000 |
| Mailing Telephone | 7014176000 |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2016-04-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 697-15 | ND | Other Service Providers |
| Y | 174400000X | Specialist | 2747 | MN | Other Service Providers |
| Street Address |
2301 25TH ST S |
| City | FARGO |
| State | ND |
| Zip Code | 58103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215917992 | Arezoo Taheri | Internal Medicine | 2301 25th St S, Ste I, Fargo, ND 58103 | 2006-01-19 |
| 1437786860 | Derek Weninger | Physician Assistant | 2301 25th St S, Fargo, ND 58103-6104 | 2020-03-25 |
| 1578196853 | Jade Storley | Physician Assistant | 2301 25th St S, Fargo, ND 58103-6104 | 2020-02-14 |
| 1881225837 | Whitney Marie Krabbenhoft | Physician Assistant | 2301 25th St S, Fargo, ND 58103-6104 | 2020-01-29 |
| 1477113439 | Matthew Philip Mcmanus | Specialist/Technologist | 2301 25th St S, Fargo, ND 58103-6104 | 2019-06-20 |
| 1467938886 | Cassandra Staber | Physician Assistant | 2301 25th St S, Fargo, ND 58103-6104 | 2018-07-18 |
| 1194201624 | Alec Michelle Aman | Physical Therapist | 2301 25th St S, Fargo, ND 58103-6104 | 2018-07-18 |
| 1639679624 | Andrew Macgregor | Physician Assistant | 2301 25th St S, Fargo, ND 58103-6104 | 2018-02-15 |
| 1851890396 | Jordan Iverson | Physician Assistant | 2301 25th St S, Fargo, ND 58103-6104 | 2018-02-11 |
| 1740789726 | Melisha Ann Vannett | Nurse Practitioner | 2301 25th St S, Fargo, ND 58103-6104 | 2018-02-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
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| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811392657 | Beth Schaible | Specialist | 4152 30th Ave S Ste 102, Fargo, ND 58104-8403 | 2014-10-22 |
| 1992113203 | Tara Marie Jaeger | Specialist | 3491 University Dr S, Fargo, ND 58104-6225 | 2014-07-30 |
| 1427329069 | Joshua D Lindsey | Specialist | 3303 23rd Ave S, Fargo, ND 58103-6277 | 2012-01-12 |
| 1457594079 | Manisha Balhara | Specialist | 2400 32nd Avenue S, Fargo, ND 58122 | 2009-04-13 |
| 1568643823 | Gary A. Matthys Md Plc | Specialist | 2301 25th St S Ste I, Fargo, ND 58103-6104 | 2007-11-15 |
| 1861427338 | Paula Kathryn Schmalz | Specialist | 84 Prairiewood Dr S, Fargo, ND 58103-4609 | 2006-07-12 |
| 1578509733 | Lance K Bergstrom | Specialist | 2601 University Dr S, Fargo, ND 58103-6025 | 2006-06-22 |
| 1669420923 | Neuropsychology Associates, Pa | Specialist | 1220 Main Ave Ste 100, Fargo, ND 58103-8201 | 2006-05-05 |
| 1932185451 | Kristen E Cain | Specialist | 1111 Harwood Ave, Fargo, ND 58104 | 2005-12-16 |
| 1578161154 | Madison Krupke | Specialist | 1126 Westrac Dr S, Fargo, ND 58103-2473 | 2020-10-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.