Individual provider Active NPI

Jessica Jean Larson, NP-C

  • Family Nurse Practitioner
  • Devils Lake, ND
National Provider Identifier
1083901490
Registry record updated May 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R32637 Issued in ND
Practice address
210 Highway 2 W Ste 8
Devils Lake, ND 58301-2913
Phone
(701) 622-2039
Fax
(701) 662-2049
NPI assigned
Jul 6, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R32637 ND Primary

Addresses

Primary practice location

210 Highway 2 W Ste 8
Devils Lake, ND 58301-2913

Mailing address

145 Main St E # 232
Leeds, ND 58346-7155
Phone (701) 739-4228

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
I20110920000174 ND Practitioner - Nurse Practitioner 2163693342 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Grace and Gratitude WellnessGroup PAC ID 7517483001, 2 clinicians

Practice addresses (Care Compare)

210 Hwy 2 W
Suite 8
Devils Lake, ND 58301-2913
Phone (701) 662-2039

Hospital & facility affiliations

  • Towner County Medical Center Hospital, Cando, ND, CCN 351331
  • Altru Hospital Hospital, Grand Forks, ND, CCN 350019

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Grace and Gratitude Wellness Family CurrentSince Feb 17, 2025 Accepting new patients

Locations

210 Highway 2 W
Ste 8
Devils Lake, ND 58301
Phone (701) 622-2039

210 Highway 2 W
Ste 8A
Devils Lake, ND 58301

Organizations & group practices 1

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

Hospital & facility affiliations 2

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": "1309910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748217600000",
    "number": "1083901490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 MAIN ST E # 232",
            "city": "LEEDS",
            "state": "ND",
            "postal_code": "583467155",
            "telephone_number": "701-739-4228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 HIGHWAY 2 W STE 8",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012913",
            "telephone_number": "701-622-2039",
            "fax_number": "701-662-2049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JESSICA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-06",
        "last_updated": "2025-05-26",
        "certification_date": "2025-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R32637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Devils Lake, ND

Sources for this page

Verify at the official NPI Registry.