Healthcare Provider Details

I. General information

NPI: 1588620728
Provider Name (Legal Business Name): PATRICIA A KLINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 20TH ST SW
JAMESTOWN ND
58401-6201
US

IV. Provider business mailing address

PO BOX 6001
FARGO ND
58108-6001
US

V. Phone/Fax

Practice location:
  • Phone: 701-253-5300
  • Fax: 701-253-5402
Mailing address:
  • Phone: 701-253-5300
  • Fax: 701-253-5402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46226
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7567
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: