Healthcare Provider Details

I. General information

NPI: 1619920345
Provider Name (Legal Business Name): CAMMY KAY KELSCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMMY KAY KELSCH FNP

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 9TH ST
BISMARCK ND
58501
US

IV. Provider business mailing address

2975 HIGHWAY 2 E
RUGBY ND
58368-7801
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-6036
  • Fax: 701-530-6488
Mailing address:
  • Phone: 701-400-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number467
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: