Individual provider Active NPI

Kylie Knutson

  • Physician Assistant
  • Fargo, ND
National Provider Identifier
1083475446
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC1068 Issued in ND
Practice address
1717 S University Drive
Fargo, ND 58103-4939
Phone
(701) 280-4640
NPI assigned
Jan 22, 2024
Last updated
Mar 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PAC1068 ND Primary

Addresses

Primary practice location

1717 S University Drive
Fargo, ND 58103-4939

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-9419

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240524000914 ND Practitioner - Physician Assistant 9638511421 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

1711 University Dr S
Fargo, ND 58103-4939
Phone (701) 417-5710

1717 University Dr S
Fargo, ND 58103-4939
Phone (701) 234-2000

5225 23Rd Ave S
Fargo, ND 58104-7927
Phone (701) 417-2575

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PAC1068NDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo Current Accepting new patients
Sanford Medical Center Fargo CurrentSince Apr 22, 2024 Accepting new patients
Sanford Bismarck CurrentSince Feb 24, 2025 Accepting new patients
Sanford Medical Center Fargo CurrentSince Apr 22, 2024 Accepting new patients
Sanford Clinic North Past Accepting new patients

Locations

222 N 7th St
Bismarck, ND 58501
Phone (701) 323-5422

300 N 7th St
Bismarck, ND 58501
Phone (701) 323-6153

3318 N 14th St
Bismarck, ND 58503
Phone (701) 323-8300

1717 University Dr S
Fargo, ND 58103
Phone (701) 234-4111

5225 23rd Ave S
Fargo, ND 58104
Phone (701) 234-5933

801 Broadway N
Fargo, ND 58102
Phone (701) 234-2371

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1083475446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-9419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S UNIVERSITY DRIVE",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034939",
            "telephone_number": "701-280-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNUTSON",
        "first_name": "KYLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-22",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC1068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.