Healthcare Provider Details

I. General information

NPI: 1760349393
Provider Name (Legal Business Name): KELLY MCGRADY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 TIFFANY DRIVE, BISMARCK, ND, USA
BISMARCK ND
58504
US

IV. Provider business mailing address

6200 TIFFANY DRIVE, BISMARCK, ND, USA
BISMARCK ND
58504
US

V. Phone/Fax

Practice location:
  • Phone: 701-421-7820
  • Fax:
Mailing address:
  • Phone: 701-421-7820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number203922
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: