Healthcare Provider Details

I. General information

NPI: 1508217373
Provider Name (Legal Business Name): KIRSTIE GILLETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTIE GILLETT

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 7TH ST NE
DEVILS LAKE ND
58301-2719
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201-4183
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-2158
  • Fax:
Mailing address:
  • Phone: 701-780-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR37194
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: