Healthcare Provider Details

I. General information

NPI: 1679404750
Provider Name (Legal Business Name): KENNEDY EMMA ISABELLE PLEETS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 LOANS HIM ARROW LOOP
FORT YATES ND
58538-2202
US

IV. Provider business mailing address

8850 LOANS HIM ARROW LOOP
FORT YATES ND
58538-2202
US

V. Phone/Fax

Practice location:
  • Phone: 701-301-4323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: