Provider Demographics
NPI:1114058468
Name:KELLY, DARLENE C (ARNP)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:C
Last Name:KELLY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N MAIN STREET
Mailing Address - Street 2:PO BOX 307
Mailing Address - City:MCVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58254-0307
Mailing Address - Country:US
Mailing Address - Phone:701-322-4347
Mailing Address - Fax:701-322-2250
Practice Address - Street 1:108 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:MCVILLE
Practice Address - State:ND
Practice Address - Zip Code:58254-0307
Practice Address - Country:US
Practice Address - Phone:701-322-4347
Practice Address - Fax:701-322-2250
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR17289363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19526Medicaid
ND19526Medicaid
ND13401Medicare ID - Type UnspecifiedMCVILLE