Valley Dermatology Clinic PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

VALLEY DERMATOLOGY CLINIC PC

Practice address

3270 20TH St S
Fargo, ND 58104-5917

Phone

(701) 293-7408

Fax

(701) 235-2099

NPI assigned

Nov 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly Kelly, MDNPI 1245223023

Title

Owner

Phone

(701) 293-7408

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Rae Kelly, MD

  • Dermatology Physician
  • Fargo, ND
  • NPI 1245223023
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043380223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3270 20TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581045917",
            "telephone_number": "701-293-7408",
            "fax_number": "701-235-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3270 20TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581045917",
            "telephone_number": "701-293-7408",
            "fax_number": "701-235-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY DERMATOLOGY CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-293-7408",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "06546001",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13495",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "510R8VA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Francesco Valente
• Valley Anesthesia Associates PC
• Valley Bariatric & Wellness Clinic
• Valley Christian Counseling Center Inc
• Valley Dental Center, PC
• Valley Homes LLC
• Valley Laser Eye Center L.L.C.
• Valley Medical Clinic PC
• Valley Oral & Facial Surgery PC
• Valley Senior Services

• Dermatology Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• Dermatology Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.