Provider Demographics
NPI:1346725900
Name:O'HARRIS, KELSEY LEIGH (CNM)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEIGH
Last Name:O'HARRIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LEIGH
Other - Last Name:SOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7416 W 104TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-2115
Mailing Address - Country:US
Mailing Address - Phone:952-456-2596
Mailing Address - Fax:
Practice Address - Street 1:301 NP AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4835
Practice Address - Country:US
Practice Address - Phone:701-271-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-30
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR46825367A00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse