KIMBERLY RAE KELLY (NPI# 1245223023) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245223023 |
| Entity Type | Individual |
| Full Name | KIMBERLY RAE KELLY |
| Credential | MD |
| Practice Address |
1702 University Dr S Fargo ND 58103-4940 |
| Mailing Address |
Po Box 6001 Fargo ND 58108-6001 |
| Practice Telephone | 7013643300 |
| Practice Fax Number | 7013648906 |
| Mailing Telephone | 7013643300 |
| Mailing Fax Number | 7013648906 |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2011-08-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | 33100 | MN | Allopathic & Osteopathic Physicians |
| Y | 207N00000X | Dermatology | 5817 | ND | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | BLUE SHIELD | 25535 | 01 |
| MN | BLUE SHIELD | 511R8KE | 01 |
| HEALTHPARTNERS | HP17495 | 01 | |
| MEDICA | 0300403 | 01 | |
| ND | 16323 | 05 | |
| MN | MEDICAL ASSISTANCE | 772090400 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083252878 | Kimberly Anne Kelly | Nurse Practitioner | 3056 Hickory St, Yorktown Heights, NY 10598-2734 | 2019-12-12 |
| 1023503919 | Kimberly Kelly | Counselor | 1382 Bull Lea Rd, Lexington, KY 40511-1247 | 2018-06-25 |
| 1265812085 | Kimberly Kelly | Counselor | 80 Kleyona Ave, Phoenixville, PA 19460-2568 | 2015-06-06 |
| 1144600115 | Kimberly Ann Kelly | Dietitian, Registered | 3550 Ballina Canyon Rd, Encino, CA 91436-4108 | 2015-06-04 |
| 1922403955 | Kimberly C. Kelly | Behavioral Analyst | 62 Lowell St Ste 5, Manchester, NH 03101-1607 | 2014-11-04 |
| 1710390828 | Kimberly Kelly | Speech-Language Pathologist | 1313 Southside Cir, Nashville, TN 37212-2442 | 2014-06-05 |
| 1669727186 | Kimberly Kelly | Social Worker | 2750 Sutterville Road, Sacramento, CA 95820 | 2012-07-20 |
| 1174833966 | Kimberly Sue Kelly | Psychologist | 630 S Woodruff Ave, Idaho Falls, ID 83401-5299 | 2010-10-14 |
| 1245460120 | Kimberly A Kelly | Pharmacist | 8571 Rivers Ave, North Charleston, SC 29406-9208 | 2009-07-24 |
| 1992944870 | Kimberly Ann Kelly | Counselor | 114 E Bolton St, Pontotoc, MS 38863-1506 | 2009-02-17 |
| Street Address |
1702 UNIVERSITY DR S |
| City | FARGO |
| State | ND |
| Zip Code | 58103-4940 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467060046 | Jessica Marie Munro | Optometrist | 1702 University Dr S, Fargo, ND 58103-4940 | 2020-07-20 |
| 1972132249 | Kalee Irene Wysuph | Student in an Organized Health Care Education/Training Program | 1702 University Dr S, Fargo, ND 58103-4940 | 2020-04-07 |
| 1699314617 | April M Sweet | Nurse Practitioner | 1702 University Dr S, Fargo, ND 58103-4940 | 2019-12-23 |
| 1427603588 | Annelise Sterneman | Nurse Practitioner | 1702 University Dr S, Fargo, ND 58103-4940 | 2019-08-06 |
| 1518511799 | Morgan A Schmitz | Nurse Practitioner | 1702 University Dr S, Fargo, ND 58103-4940 | 2019-07-26 |
| 1093367799 | Josalyn J Grueneich | Nurse Practitioner | 1702 University Dr S, Fargo, ND 58103-4940 | 2019-07-12 |
| 1295395176 | Amanda J Coronato | Occupational Therapist | 1702 University Dr S, Fargo, ND 58103-4940 | 2019-06-13 |
| 1962976068 | Moriah M Anderson | Dietitian, Registered | 1702 University Dr S, Fargo, ND 58103-4940 | 2019-01-11 |
| 1811489743 | Karli Lenae Roman | Nurse Practitioner | 1702 University Dr S, Fargo, ND 58103-4940 | 2018-06-06 |
| 1548777584 | Allison R Klug | Chiropractor | 1702 University Dr S, Fargo, ND 58103-4940 | 2017-12-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
| Find all providers in zip 58103 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205031713 | Rachel C Ness | Dermatology | 3173 43rd Street S Ste A, Fargo, ND 58104-4564 | 2007-06-15 |
| 1902978455 | Beth A Honl | Dermatology | 4133 30th Ave S Ste 101, Fargo, ND 58104-8421 | 2006-11-13 |
| 1952408809 | Chetan P Maingi | Dermatology | 4556 40th Avenue South, Suite 130, Fargo, ND 58104 | 2006-09-20 |
| 1639121304 | Thomas J Matzke | Dermatology | 4656 40th Ave S, Fargo, ND 58104-4397 | 2006-05-17 |
| 1912359977 | Natalie Marie Kollman | Dermatology | 1702 University Dr S, Fargo, ND 58103-4940 | 2016-07-01 |
| 1043666274 | Dong Kim | Dermatology | 1702 University Dr S, Fargo, ND 58103-4940 | 2016-05-06 |
| 1225440324 | Ryan Bogner | Dermatology | 4656 40th Ave S, Fargo, ND 58104-4397 | 2014-05-22 |
| 1518247816 | Sanford Medical Center Fargo | Dermatology | 4656 40th Ave S, Fargo, ND 58104-4397 | 2011-08-18 |
| 1952539223 | Tania Marie Gonzalez Santiago | Dermatology | 4656 40th Ave S, Fargo, ND 58104-4397 | 2009-06-25 |
| 1780826867 | Michael Blankinship | Dermatology | 1702 University Dr S, Fargo, ND 58103-4940 | 2009-04-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.