Provider Demographics
NPI:1831123744
Name:KESSEL, RYAN T (PAC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:T
Last Name:KESSEL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1783081OtherAMERICA'S PPO/ARAZ #
MN43G60KEOtherMNBS #
ND0111441OtherMEDICA #
MN0111442OtherMEDICA #
MN20679OtherNDBS #
ND0118217OtherMEDICA #
ND270400500Medicaid
NDDA9011028272OtherPREFERRED ONE #
ND142336OtherUCARE #
MN43G59KEOtherMNBS #
MN0111443OtherMEDICA #
NDHP28585OtherHEALTHPARTNERS #
ND45G58KEOtherMNBS #
NDP37954Medicare UPIN
MN970023454Medicare UPIN
MN970001224Medicare ID - Type UnspecifiedMN MEDICARE #
MN970030237Medicare ID - Type UnspecifiedRR MEDICARE #
MN0111442OtherMEDICA #
MN43G59KEOtherMNBS #
ND1783081OtherAMERICA'S PPO/ARAZ #
ND20677Medicare ID - Type UnspecifiedND MEDICARE #