Provider Demographics
NPI:1619920345
Name:KELSCH, CAMMY KAY (FNP)
Entity Type:Individual
Prefix:
First Name:CAMMY
Middle Name:KAY
Last Name:KELSCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAMMY
Other - Middle Name:KAY
Other - Last Name:KELSCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:800 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-2118
Mailing Address - Country:US
Mailing Address - Phone:701-400-0030
Mailing Address - Fax:
Practice Address - Street 1:401 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-530-6036
Practice Address - Fax:701-530-6488
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND467363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner