Basic Information
| Provider Information | |||||||||
| NPI: | 1376128173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAY | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | APRN,CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1702 UNIVERSITY DR S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581034940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 MICHIGAN AVE W | ||||||||
| Address2: | |||||||||
| City: | WALKER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564842274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2185473452 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2021 | ||||||||
| LastUpdateDate: | 03/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 7585 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.