Healthcare Provider Details

I. General information

NPI: 1477007367
Provider Name (Legal Business Name): KELSEY L KUYLEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 7TH ST W
DICKINSON ND
58601-4335
US

IV. Provider business mailing address

PO BOX 406
DICKINSON ND
58602-0406
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-6666
  • Fax: 701-483-6667
Mailing address:
  • Phone: 701-260-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR35654
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: