Healthcare Provider Details

I. General information

NPI: 1376128173
Provider Name (Legal Business Name): KELSEY R STAY APRN,CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/04/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FARGO VAHCS 2101 ELM STREET
FARGO ND
58102
US

IV. Provider business mailing address

FARGO VAHCS 2101 ELM STREET
FARGO ND
58102
US

V. Phone/Fax

Practice location:
  • Phone: 800-410-9723
  • Fax:
Mailing address:
  • Phone: 800-410-9723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7585
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: