Healthcare Provider Details

I. General information

NPI: 1104744986
Provider Name (Legal Business Name): CHELSEY LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 HWY 24 PO BOX D
FORT YATES ND
58538
US

IV. Provider business mailing address

9305 HWY 24 PO BOX D
FORT YATES ND
58538
US

V. Phone/Fax

Practice location:
  • Phone: 701-854-3856
  • Fax:
Mailing address:
  • Phone: 701-854-3856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: