Individual
KELLY BAK642932 BAKKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
409 OAK ST, GRAND FORKS, ND 58201-4453
(701) 410-7862
Mailing address
409 OAK ST, GRAND FORKS, ND 58201-4453
(701) 410-7862
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
08/06/2025
Last updated
08/06/2025
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