Provider Demographics
NPI:1841603933
Name:AMAN, KELSEY
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:
Last Name:AMAN
Suffix:
Gender:F
Credentials:
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 2418
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-2418
Mailing Address - Country:US
Mailing Address - Phone:218-791-1515
Mailing Address - Fax:
Practice Address - Street 1:201 5TH ST NW
Practice Address - Street 2:SUITE NUMBER 790
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-7119
Practice Address - Country:US
Practice Address - Phone:701-444-3661
Practice Address - Fax:701-444-6436
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4797171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND000079471Medicaid