Healthcare Provider Details

I. General information

NPI: 1720913544
Provider Name (Legal Business Name): KRISTEN KELLI COUTURE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4133 30TH AVE S STE 104
FARGO ND
58104-8421
US

IV. Provider business mailing address

2836 41ST ST S APT 411
FARGO ND
58104-9092
US

V. Phone/Fax

Practice location:
  • Phone: 701-314-4008
  • Fax: 701-829-7247
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2026-01
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: