Individual provider Active NPI

Kristina M Childress, APRN, CNP

  • Family Nurse Practitioner
  • Fargo, ND
National Provider Identifier
1568877322
Registry record updated May 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R30216 Issued in ND
Practice address
3000 32ND Ave S
Fargo, ND 58103-6132
Phone
(701) 364-8000
Fax
(701) 364-8078
NPI assigned
Jun 30, 2014
Last updated
May 28, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2934 MN
Family Nurse Practitioner 363LF0000X R30216 ND Primary

Addresses

Primary practice location

3000 32ND Ave S
Fargo, ND 58103-6132

Mailing address

1702 University Dr S
Fargo, ND 58103-4940

Other identifiers 1

IdentifierTypeStateIssuer
1460305MedicaidND

Other names 1

  • Kristina M Norman Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140908002784 ND Practitioner - Nurse Practitioner 7517186455 Reassigns benefits to 1 organization
I20150102001598 MN Practitioner - Nurse Practitioner 7517186455 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of North Dakota School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Marys Regional Health CenterGroup PAC ID 2062326820, 190 clinicians
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 844-2300

2430 20TH St SW
Jamestown, ND 58401-6201
Phone (701) 253-5300

275 11TH St S
Wahpeton, ND 58075-4655
Phone (701) 642-2000

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

705 Pleasant Ave S
Park Rapids, MN 56470-1440
Phone (218) 732-2800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2934MNMDPhysical Therapist
R30216NDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health LLC CurrentSince Sep 8, 2014 Accepting new patients
Innovis Health, LLC Current Accepting new patients
St Mary's Regional Health Center CurrentSince Jan 8, 2015 Accepting new patients
Innovis Health LLC CurrentSince Sep 8, 2014 Accepting new patients
St. Marys Regional Health Center Current Accepting new patients
St Mary's Regional Health Center CurrentSince Jan 8, 2015 Accepting new patients
St Marys Regional Health Center Past Accepting new patients

Locations

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

705 Pleasant Ave S
Park Rapids, MN 56470
Phone (218) 732-2800

1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-4222

Organizations & group practices 7

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 6

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": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590624000000",
    "number": "1568877322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 32ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036132",
            "telephone_number": "701-364-8000",
            "fax_number": "701-364-8078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDRESS",
        "first_name": "KRISTINA",
        "middle_name": "M",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-30",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "2934",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R30216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1460305",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "NORMAN",
            "middle_name": "M",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.