Provider Demographics
NPI:1043098890
Name:CASTO, KELLIE M
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:M
Last Name:CASTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 3RD AVE NE UNIT A
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2118
Mailing Address - Country:US
Mailing Address - Phone:402-253-9307
Mailing Address - Fax:
Practice Address - Street 1:8611 53RD ST NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-9540
Practice Address - Country:US
Practice Address - Phone:701-230-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant