Provider Demographics
NPI:1558701615
Name:PFAFF, KELLI LYNN (APRN, CNP)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:LYNN
Last Name:PFAFF
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:LYNN
Other - Last Name:ROFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1702 UNIVERSITY DR S # SSC
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:701-364-8508
Mailing Address - Fax:
Practice Address - Street 1:4476 31ST AVE S STE 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4532
Practice Address - Country:US
Practice Address - Phone:701-234-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDF0613003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDF0613003OtherND CERTIFICATION