Provider Demographics
NPI:1598243321
Name:KRICK, KORTNEY MARIE (FNP)
Entity Type:Individual
Prefix:DR
First Name:KORTNEY
Middle Name:MARIE
Last Name:KRICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122-0001
Mailing Address - Country:US
Mailing Address - Phone:701-234-1113
Mailing Address - Fax:701-234-2045
Practice Address - Street 1:249 5TH ST E
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:MN
Practice Address - Zip Code:56175
Practice Address - Country:US
Practice Address - Phone:507-629-8400
Practice Address - Fax:507-629-8401
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF06181073363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner