Healthcare Provider Details

I. General information

NPI: 1942138664
Provider Name (Legal Business Name): KELSEY MISCHEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W FRONT AVE
BISMARCK ND
58504-5514
US

IV. Provider business mailing address

207 W FRONT AVE
BISMARCK ND
58504-5514
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-0994
  • Fax: 701-751-1657
Mailing address:
  • Phone: 701-751-0994
  • Fax: 701-751-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2861
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: