Healthcare Provider Details

I. General information

NPI: 1821923038
Provider Name (Legal Business Name): CLIFFORD KEDDIE CONTEH APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 RAMSEY ST
HASTINGS MN
55033-3126
US

IV. Provider business mailing address

1502 RAMSEY ST
HASTINGS MN
55033-3126
US

V. Phone/Fax

Practice location:
  • Phone: 952-240-2874
  • Fax:
Mailing address:
  • Phone: 952-240-2874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2471759
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: