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30 7th St W Dickinson ND 58601-4335 | |
| (701) 690-2360 | |
| (701) 291-4747 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 30 7th St W, Dickinson, North Dakota |
| Authorized Official Name and Position | Kelly M Chevalier (OWNER) |
| Authorized Official Contact | 7016902360 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1665 Prairie Creek Rd Dickinson ND 58601-2997 Ph: (208) 794-5314 | 30 7th St W Dickinson ND 58601-4335 Ph: (701) 690-2360 |
| NPI Number | 1528808573 |
|---|---|
| Provider Enumeration Date | 05/28/2024 |
| Last Update Date | 12/11/2024 |
| Certification Date | 12/11/2024 |
| Medicare PECOS PAC ID | 7719420694 |
|---|---|
| Medicare Enrollment ID | O20240620000282 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528808573 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kelly M Chevalier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922743103 PECOS PAC ID: 8628436540 Enrollment ID: I20230623002345 |
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