Provider Type Icon

KIMBERLY RAE KELLY MD NPI 1245223023


NPI Information

NPI: 1245223023
Provider Name: KIMBERLY RAE KELLY, MD
Classification: Dermatology - 207N00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
1702 UNIVERSITY DR S
FARGO, ND
ZIP 58103
Phone: (701) 364-3300
Get Directions

Kimberly Rae Kelly, MD is a dermatology in Fargo, ND. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. Kimberly Rae Kelly, MD NPI is 1245223023. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1702 UNIVERSITY DR S
FARGO, ND
ZIP 58103-940
Phone: (701) 364-3300
Fax: (701) 364-8906

The NPI 1245223023 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Tangential biopsy of single skin lesion (HCPCS:11102)

The enumeration date for this NPI number is 8/26/2005 and was last updated on 8/25/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatology33100MINNESOTANo
2207N00000XDermatology5817NORTH DAKOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
116323MEDICAIDNORTH DAKOTA
2511R8KEOTHERMINNESOTABLUE SHIELD
30300403OTHERMEDICA
4HP17495OTHERHEALTHPARTNERS
525535OTHERNORTH DAKOTABLUE SHIELD
6N713486MEDICARE PINNORTH DAKOTA
7772090400OTHERMINNESOTAMEDICAL ASSISTANCE
8B54080MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.