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General NPI Number Information
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NPI Number | 1831970599
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Entity Type | Individual
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Provider Name | KELLEY JEAN VIGSTOL CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 2305 37TH AVE SW
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City | MINOT
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State | ND
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Zip | 58701-7669
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Country | US
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Telephone | 701-418-8342
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5010
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City | MINOT
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State | ND
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Zip | 58702-5010
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Country | US
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Telephone | 701-857-3517
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Fax | 701-418-8621
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 205980
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | R47259
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License Number State | ND
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