Individual provider Active NPI

Julie Marie Ketterling, FNP

  • Family Nurse Practitioner
  • Fargo, ND
National Provider Identifier
1679923940
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R35151 Issued in ND
Practice address
2400 32ND Ave S
Fargo, ND 58103-5800
Phone
(701) 234-2000
NPI assigned
Jun 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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 R35151 ND Primary

Addresses

Primary practice location

2400 32ND Ave S
Fargo, ND 58103-5800

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585

Other names 1

  • Miss Julie Marie Hageman Former 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
I20160811000204 ND Practitioner - Nurse Practitioner 3870887078 Reassigns benefits to 1 organization
I20250505002246 MN Practitioner - Nurse Practitioner 3870887078 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innovis Health LLCGroup PAC ID 9931298155, shared by 7 NPIs, 561 clinicians

Practice addresses (Care Compare)

4110 51St Ave S
Fargo, ND 58104-7776
Phone (701) 364-3100

720 Main Ave
Moorhead, MN 56560-2752
Phone (218) 359-0399

Hospital & facility affiliations

  • Essentia Health Hospital, Fargo, ND, CCN 350070

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health LLC Current Accepting new patients
Innovis Health, LLC Current Accepting new patients
Innovis Health LLC CurrentSince Feb 17, 2025 Accepting new patients
Innovis Health, LLC. CurrentSince Mar 2, 2025 Accepting new patients
Innovis Health LLC CurrentSince Feb 17, 2025 Accepting new patients

Locations

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

720 Main Ave
Moorhead, MN 56560
Phone (218) 359-0399

208 Oppegard Ave NW
Twin Valley, MN 56584
Phone (218) 584-5181

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

4110 51st Ave S
Fargo, ND 58104
Phone (701) 364-3100

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1466121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1679923940",
    "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": "605-328-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 32ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581035800",
            "telephone_number": "701-234-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTERLING",
        "first_name": "JULIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-17",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R35151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JULIE",
            "last_name": "HAGEMAN",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.