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Individual

VICKI L KJOS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3902 13TH AVE S, FARGO, ND 58103
(701) 364-6600
(701) 364-6628
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-4222

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0224
ND
363A00000X
Physician Assistant
9326
MN
363AM0700X
Medical Physician Assistant
5243
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
744746
AZ
Enumeration date
07/17/2006
Last updated
08/20/2018
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