Healthcare Provider Details

I. General information

NPI: 1437005907
Provider Name (Legal Business Name): KELSIE BORDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 13TH AVE S
FARGO ND
58103-3357
US

IV. Provider business mailing address

3902 13TH AVE S
FARGO ND
58103-3357
US

V. Phone/Fax

Practice location:
  • Phone: 701-282-2268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number45-0319585
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: