Healthcare Provider Details

I. General information

NPI: 1164314811
Provider Name (Legal Business Name): KATELYN MARY DESAUTEL THOMPSON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W 13TH ST
GRAFTON ND
58237-1826
US

IV. Provider business mailing address

1145 WESTERN AVE
GRAFTON ND
58237-2239
US

V. Phone/Fax

Practice location:
  • Phone: 701-352-1620
  • Fax:
Mailing address:
  • Phone: 701-360-1649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202850
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: