Provider Demographics
NPI:1952699282
Name:LEIPHON, KELLY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:LEIPHON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:HOLMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:1001 7TH STREET NE
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-1100
Mailing Address - Country:US
Mailing Address - Phone:701-662-2157
Mailing Address - Fax:701-662-4116
Practice Address - Street 1:1001 7TH ST NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2719
Practice Address - Country:US
Practice Address - Phone:701-662-2157
Practice Address - Fax:701-662-4116
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR33898363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner