Healthcare Provider Details

I. General information

NPI: 1649664343
Provider Name (Legal Business Name): KELSEY LINDQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 01/16/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 10TH ST SW STE A
MINOT ND
58701-6913
US

IV. Provider business mailing address

2900 10TH ST SW STE A
MINOT ND
58701-6913
US

V. Phone/Fax

Practice location:
  • Phone: 701-839-4102
  • Fax:
Mailing address:
  • Phone: 701-839-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2099
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: