Provider Demographics
NPI:1417932823
Name:KELSEN, MEREDITH K (NP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:K
Last Name:KELSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:K
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:10 9TH AVE E
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ND
Mailing Address - Zip Code:58054
Mailing Address - Country:US
Mailing Address - Phone:701-683-4711
Mailing Address - Fax:701-683-3205
Practice Address - Street 1:10 9TH AVE E
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ND
Practice Address - Zip Code:58054
Practice Address - Country:US
Practice Address - Phone:701-683-4711
Practice Address - Fax:701-683-3205
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR27855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND05171Medicaid
ND022192OtherNDBS
ND19709Medicaid
ND353852Medicare ID - Type UnspecifiedMEDICARE RHC FACILITY
NDP64431Medicare UPIN
ND22192Medicare ID - Type Unspecified