Basic Information
| Provider Information | |||||||||
| NPI: | 1831123744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KESSEL | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 32ND AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581036132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013648000 | ||||||||
| FaxNumber: | 7013648078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PAC0267 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1783081 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | 43G60KE | 01 | MN | MNBS # | OTHER | 0111441 | 01 | ND | MEDICA # | OTHER | 0111442 | 01 | MN | MEDICA # | OTHER | 20679 | 01 | MN | NDBS # | OTHER | 0118217 | 01 | ND | MEDICA # | OTHER | 270400500 | 05 | ND | MEDICAID | DA9011028272 | 01 | ND | PREFERRED ONE # | OTHER | 142336 | 01 | ND | UCARE # | OTHER | 43G59KE | 01 | MN | MNBS # | OTHER | 0111443 | 01 | MN | MEDICA # | OTHER | HP28585 | 01 | ND | HEALTHPARTNERS # | OTHER | 45G58KE | 01 | ND | MNBS # | OTHER |