Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R36365 | ND |
NPI | 1003267394 |
---|---|
Provider Name | Mrs. Kayla L. Nelson |
First Address | Fargo, ND 58102-4835 |
Second Address | Fargo, ND 58102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2016 |
Last Update Date | 21/09/2018 |