Glick, Kelly Leah

Glick, Kelly Leah is an individual health care provider with primary practice located at 2500 Fairway St , Dickinson ND 58601-2639. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Glick, Kelly Leah can be contacted via phone (701) 456-4200.

Contact Information

Primary practice address
2500 Fairway St Dickinson ND 58601-2639
Phone: (701) 456-4200
Fax: (701) 456-4545
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PAC0507 North Dakota

Profile Details

NPI number 1578817466
LBN Legal business name Glick, Kelly Leah
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 31st, 2012
Last updated Mar 15th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578817466 NPPES
North Dakota MEDICAID 1452926
North Dakota MEDICAID 71219

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