Individual
DR. KELLY CRAGHILL FAGERBURG SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1308 23RD ST S, FARGO, ND 58103-3707
(701) 297-7540
(701) 297-6439
Mailing address
1308 23RD ST S, FARGO, ND 58103-3707
(701) 297-7540
(701) 297-6439
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
473
ND
103TC0700X
Clinical Psychologist
473
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17313
—
ND
Enumeration date
10/22/2012
Last updated
03/11/2015
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