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General NPI Number Information
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NPI Number | 1609789700
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Entity Type | Individual
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Provider Name | KEARYN NELSEN
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Gender | Female
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 2512 S WASHINGTON ST
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City | GRAND FORKS
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State | ND
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Zip | 58201-6772
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Country | US
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Telephone | 701-330-4818
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Fax | 701-335-7242
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Provider Business Mailing Address
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Address Line | 610 4TH ST SE
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City | LEEDS
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State | ND
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Zip | 58346-7103
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2305
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License Number State | ND
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