Healthcare Provider Details

I. General information

NPI: 1144143322
Provider Name (Legal Business Name): KRISTY NELSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 1ST AVE E
WILLISTON ND
58801-5441
US

IV. Provider business mailing address

1314 10TH AVE W
WILLISTON ND
58801-4048
US

V. Phone/Fax

Practice location:
  • Phone: 701-570-5513
  • Fax:
Mailing address:
  • Phone: 701-570-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1569
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: