Kevin Kurt Axtman

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

R35002 Issued in ND

Practice address

1115 Westport Beach Way Unit B
West Fargo, ND 58078-8848

Phone

(701) 240-1758

NPI assigned

Nov 30, 2016

Last updated

Nov 30, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480464000000",
    "number": "1063955532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 WESTPORT BEACH WAY UNIT B",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580788848",
            "telephone_number": "701-240-1758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 WESTPORT BEACH WAY UNIT B",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580788848",
            "telephone_number": "701-240-1758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AXTMAN",
        "first_name": "KEVIN",
        "middle_name": "KURT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-30",
        "last_updated": "2016-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "ND",
            "license": "R35002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Registered Nurse in West Fargo, ND
• Providers in West Fargo, ND by specialty
• Psychiatric/Mental Health Registered Nurse in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; 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.