Healthcare Provider Details

I. General information

NPI: 1821901042
Provider Name (Legal Business Name): REBECCA KELLY
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

1293 ELBOWOODS LOOP
NEW TOWN ND
58763-3400
US

IV. Provider business mailing address

1293 ELBOWOODS LOOP
NEW TOWN ND
58763-3400
US

V. Phone/Fax

Practice location:
  • Phone: 701-627-4340
  • Fax: 701-627-4304
Mailing address:
  • Phone: 701-627-4340
  • Fax: 701-627-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number46001
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: