Provider Demographics
NPI:1427276260
Name:NELSON, KINSEY BJORN (MD)
Entity type:Individual
Prefix:MR
First Name:KINSEY
Middle Name:BJORN
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5759
Mailing Address - Country:US
Mailing Address - Phone:701-365-8700
Mailing Address - Fax:701-365-8701
Practice Address - Street 1:1800 21ST AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5759
Practice Address - Country:US
Practice Address - Phone:701-365-8700
Practice Address - Fax:701-365-8701
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND12048207Q00000X
MN51215207Q00000X
NDPT 12048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16281Medicaid
MN1427276260Medicaid
ND16281Medicaid
MN1427276260Medicaid