Healthcare Provider Details

I. General information

NPI: 1609789700
Provider Name (Legal Business Name): KEARYN NELSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 S WASHINGTON ST
GRAND FORKS ND
58201-6772
US

IV. Provider business mailing address

610 4TH ST SE
LEEDS ND
58346-7103
US

V. Phone/Fax

Practice location:
  • Phone: 701-330-4818
  • Fax: 701-335-7242
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2305
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: