Healthcare Provider Details

I. General information

NPI: 1417735234
Provider Name (Legal Business Name): KAYLA ESTENSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 23RD AVE S
FARGO ND
58104-7927
US

IV. Provider business mailing address

5225 23RD AVE S
FARGO ND
58104-7927
US

V. Phone/Fax

Practice location:
  • Phone: 701-417-2000
  • Fax:
Mailing address:
  • Phone: 701-417-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR56107
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR56107
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: