Healthcare Provider Details

I. General information

NPI: 1376407171
Provider Name (Legal Business Name): KAYLEE B CASPERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S COLUMBIA RD
GRAND FORKS ND
58201-4012
US

IV. Provider business mailing address

1300 S COLUMBIA RD
GRAND FORKS ND
58201-4012
US

V. Phone/Fax

Practice location:
  • Phone: 701-795-2099
  • Fax:
Mailing address:
  • Phone: 701-795-2099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number46850
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: