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General NPI Number Information
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NPI Number | 1093626269
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Entity Type | Individual
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Provider Name | KARLY JO KENNELLY
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Gender | Female
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Dates
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Enumeration Date | 09/15/2026
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | 213 2ND AVE NE
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City | ROLLA
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State | ND
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Zip | 58367-7153
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Country | US
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Telephone | 701-477-3161
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Fax | 701-477-5564
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Provider Business Mailing Address
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Address Line | PO BOX 31
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City | SAINT THOMAS
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State | ND
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Zip | 58276-0031
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Country | US
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Telephone | 701-520-9305
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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 | 205939
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License Number State | ND
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