Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Jacob Kohl Pederson, APRNCNP

Individual provider Gerontology Nurse Practitioner · NPI 1770243727

Mr. Jacob Kohl Pederson, APRNCNP is a Nurse Practitioner in Fargo, North Dakota. Qualified in 2021, 5 years ago. Practices with St Marys Regional Health Center, a 188-clinician group and accepts Medicare assignment. Licensed in North Dakota.

Years since qualifying
5
Licensed in
ND
In the registry since
2021

Practice location Address checks out

3000 32nd Ave S
Fargo, ND 58103-6132
Phone: (701) 364-8000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence R51672 (ND)

Record details

NPI number1770243727
Entity typeIndividual (Type 1)
GenderMale
Credentials APRNCNP
Sole proprietorNo
NPI enumeratedDecember 17, 2021
Last updated in NPPESDecember 17, 2021
Certification dateDecember 17, 2021

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice St Marys Regional Health Center — 188 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Fargo