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General NPI Number Information
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NPI Number | 1043945397
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Entity Type | Individual
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Provider Name | KELSEY VIVATSON PMHNP-BC, APRN
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Gender | Female
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 2534 17TH AVE S STE E
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City | GRAND FORKS
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State | ND
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Zip | 58201-5215
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Country | US
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Telephone | 701-885-4551
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Fax | 701-757-1351
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Provider Business Mailing Address
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Address Line | PO BOX 5459
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City | GRAND FORKS
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State | ND
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Zip | 58206-5459
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Country | US
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Telephone | 701-885-4551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R37072
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11019899
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License Number State | FL
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