Provider Demographics
NPI:1629781430
Name:NABORS, KELLAND
Entity Type:Individual
Prefix:
First Name:KELLAND
Middle Name:
Last Name:NABORS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O AKILAH ROSE
Mailing Address - Street 2:148016TH ST. EAST APT 107
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078
Mailing Address - Country:US
Mailing Address - Phone:414-415-7324
Mailing Address - Fax:
Practice Address - Street 1:C/O AKILAH ROSE
Practice Address - Street 2:148016TH ST. EAST APT 107
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078
Practice Address - Country:US
Practice Address - Phone:414-415-7324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant