Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kallie Jo Wennerberg, AGNP-C

Individual provider Nurse Practitioner · NPI 1538893920

Kallie Jo Wennerberg, AGNP-C is a Nurse Practitioner in Fargo, North Dakota. Qualified in 2022, 4 years ago. Practices with Sanford Medical Center Fargo, a 1,212-clinician group and accepts Medicare assignment. Licensed in North Dakota.

Years since qualifying
4
Licensed in
ND
In the registry since
2022
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Practice location Address checks out

736 Broadway N
Fargo, ND 58102-4421
Phone: (701) 234-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence R43359 (ND)

Record details

NPI number1538893920
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGNP-C
Sole proprietorNo
NPI enumeratedJuly 12, 2022
Last updated in NPPESFebruary 3, 2023
Certification dateFebruary 3, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Sanford Medical Center Fargo — 1212 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Fargo