Jessica Adeline Satrom, P.A-C
Physician Assistant in Fargo, ND. Individual provider (NPI-1).
NPI number1669939658
StatusActive
Last updated in NPPESApr 29, 2022
Details
- NPI
- 1669939658
- Entity type
- Individual (NPI-1)
- Name
- Jessica Adeline Satrom
- Credential
- P.A-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 26, 2019
- Certification date
- Apr 29, 2022
- Last updated
- Apr 29, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 12706 | MN | Yes |
Practice location
4656 40th Ave SFargo, ND 58104-4397
Phone 701-234-8860 · Fax 701-234-8924
Mailing address
2258 Thorndale AveNew Brighton, MN 55112-5213
Phone 701-799-9444
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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