Healthcare Provider Details

I. General information

NPI: 1689184582
Provider Name (Legal Business Name): MS. KARA ELIZABETH PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 16TH ST SW
MINOT ND
58701-7225
US

IV. Provider business mailing address

3515 16TH ST SW
MINOT ND
58701-7225
US

V. Phone/Fax

Practice location:
  • Phone: 701-838-1080
  • Fax:
Mailing address:
  • Phone: 701-838-1080
  • 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 NumberPTP-PT-LIC-21698
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: