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Contact Information

KIMBERLY R KELLY, MD
1702 UNIVERSITY DR S
FARGO, ND58103-4940
 Phone: 701-364-3300
 Fax: 701-364-8906
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for KIMBERLY R KELLY · (Female)

NPI Number 1245223023
Status Active
Credentials MD
Entity Individual
Enumeration date 08/26/2005
Last updated 08/25/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • MN License # 33100
  • ND License # 5817
  • ND Medicaid 16323
  • Other HP17495 HEALTHPARTNERS
  • Other 0300403 MEDICA
  • MN Other 511R8KE BLUE SHIELD
  • MN Other 772090400 MEDICAL ASSISTANCE
  • ND Other 25535 BLUE SHIELD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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