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General NPI Number Information
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NPI Number | 1366217978
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Entity Type | Individual
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Provider Name | KYRA DEWALD AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/24/2023
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 201 1ST AVE N
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City | JAMESTOWN
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State | ND
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Zip | 58401-3165
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Country | US
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Telephone | 701-269-2505
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Fax |
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Provider Business Mailing Address
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Address Line | 206 1ST AVE S
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City | JAMESTOWN
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State | ND
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Zip | 58401-4172
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Country | US
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Telephone |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R44656
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License Number State | ND
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