Kelly, Kimberly Rae

Kelly, Kimberly Rae is an individual health care provider with primary practice located at 1702 University Dr S , Fargo ND 58103-4940. She recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as her primary health care specialty. Kelly, Kimberly Rae can be contacted via phone (701) 364-3300.

Contact Information

Primary practice address
1702 University Dr S Fargo ND 58103-4940
Phone: (701) 364-3300
Fax: (701) 364-8906
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 5817 North Dakota
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 33100 Minnesota

Profile Details

NPI number 1245223023
LBN Legal business name Kelly, Kimberly Rae
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 26th, 2005
Last updated Aug 25th, 2011 - about 15 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 1245223023 NPPES
North Dakota MEDICAID 16323
North Dakota Other 0300403
North Dakota Other 25535
North Dakota Other 511R8KE
North Dakota Other 772090400
North Dakota Other HP17495

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