Provider Demographics
NPI:1720527872
Name:LENO, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:LENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:ND
Mailing Address - Zip Code:58045-4122
Mailing Address - Country:US
Mailing Address - Phone:701-893-8498
Mailing Address - Fax:
Practice Address - Street 1:111 9TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1831
Practice Address - Country:US
Practice Address - Phone:701-893-8498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND00000171M00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist