Active NPI
Brad Kittelson, LRD
- Registered Dietitian
- Fargo, ND
National Provider Identifier
1003237736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 397
- Practice address
- 1720 University Dr S
Fargo, ND 58103-4940 - Phone
- (701) 280-4474
- NPI assigned
- Dec 24, 2013
- Last updated
- Mar 25, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 397 | ND | Primary |
Addresses
Primary practice location
1720 University Dr S
Fargo, ND 58103-4940
Mailing address
PO Box 2168
Fargo, ND 58107-2168
Phone (701) 234-2119
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 56318 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 397 | ND | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395705600000",
"number": "1003237736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2168",
"city": "FARGO",
"state": "ND",
"postal_code": "581072168",
"telephone_number": "701-234-2119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1720 UNIVERSITY DR S",
"city": "FARGO",
"state": "ND",
"postal_code": "581034940",
"telephone_number": "701-280-4474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KITTELSON",
"first_name": "BRAD",
"credential": "LRD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-12-24",
"last_updated": "2014-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ND",
"license": "397",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "56318",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.