NPIMap

Individual provider Active NPI

Kelsey Ann Wiseman

  • Family Medicine Physician
  • Hazen, ND
National Provider Identifier
1770072837
Registry record updated Dec 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17267 Issued in ND
Practice address
510 8TH Ave NE
Hazen, ND 58545-4637
Phone
(701) 873-4445
NPI assigned
May 4, 2018
Last updated
Dec 22, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 17267 ND Primary

Addresses

Primary practice location

510 8TH Ave NE
Hazen, ND 58545-4637

Mailing address

617 4TH St NE
Hazen, ND 58545-4606
Phone (701) 648-9649

Other practice location 1

624 E Front Ave
Spokane, WA 99202-2139
Phone (509) 626-9900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210824002093 ND Practitioner - Family Practice 1456756881 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Dakota School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

510 8TH Ave NE
Hazen, ND 58545-4637
Phone (701) 748-2256

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Hazen Memorial Hospital Association CurrentSince Sep 1, 2021 Accepting new patients
Hazen Memorial Hospital Association Family Medicine Current Accepting new patients
Coal Country Community Health Center CurrentSince Sep 1, 2021 Accepting new patients
Hazen Memorial Hospital Association CurrentSince Sep 30, 2021 Accepting new patients
Hazen Memorial Hospital Association Family Medicine CurrentSince Sep 1, 2021 Accepting new patients
Coal Country Community Health Center CurrentSince Sep 1, 2021 Accepting new patients
Coal Country Community Health Center Current Accepting new patients
Beulah Community Nursing Home Past Accepting new patients

Locations

1312 Highway 49 N
Beulah, ND 58523
Phone (701) 873-4445

510 8th Ave NE
Hazen, ND 58545
Phone (701) 748-2225

220 4th Ave SW
Killdeer, ND 58640
Phone (701) 764-5822

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1525392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766361600000",
    "number": "1770072837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 4TH ST NE",
            "city": "HAZEN",
            "state": "ND",
            "postal_code": "585454606",
            "telephone_number": "701-648-9649",
            "fax_number": "701-639-4709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 8TH AVE NE",
            "city": "HAZEN",
            "state": "ND",
            "postal_code": "585454637",
            "telephone_number": "701-873-4445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "624 E Front Ave",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992022139",
            "country_code": "US",
            "telephone_number": "509-626-9900",
            "fax_number": "509-626-9917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISEMAN",
        "first_name": "KELSEY",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-04",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "17267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazen, ND

Sources for this page

Verify at the official NPI Registry.