Provider Demographics
NPI:1093473530
Name:SOGARD, KEZIA RENEA (DNP, NP-C)
Entity Type:Individual
Prefix:
First Name:KEZIA
Middle Name:RENEA
Last Name:SOGARD
Suffix:
Gender:F
Credentials:DNP, NP-C
Other - Prefix:MS
Other - First Name:KEZIA
Other - Middle Name:RENEA
Other - Last Name:SOGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KEZIA KVERNUM
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3641
Practice Address - Country:US
Practice Address - Phone:701-234-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR44485363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner