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

Mrs. Nicole Marie Kiesow, PA-C

Individual provider Physician Assistant · NPI 1356502769

Mrs. Nicole Marie Kiesow, PA-C is a Physician Assistant in Fosston, Minnesota. Qualified in 2008, 18 years ago. Practices with Headwaters Health PC, a 10-clinician group and accepts Medicare assignment.

Years since qualifying
18
In the registry since
2008
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

111 2nd St NE
Fosston, MN 56542-1301
Phone: (218) 435-1111
Fax: (218) 435-1112
Show map & directions

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1356502769
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 18, 2008
Last updated in NPPESApril 24, 2026
Certification dateApril 24, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Headwaters Health Pc — 10 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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