Provider Demographics
NPI:1316667884
Name:HITEN, KELSEY FAYE (NP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:FAYE
Last Name:HITEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-2388
Mailing Address - Country:US
Mailing Address - Phone:701-330-8358
Mailing Address - Fax:
Practice Address - Street 1:100 2ND ST S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-1977
Practice Address - Country:US
Practice Address - Phone:320-251-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2499471163W00000X
MN9485363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse