Kelly Marie Leach, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R29405 Issued in ND

Practice address

1300 S Columbia Rd
Grand Forks, ND 58201

Phone

(701) 780-2300

NPI assigned

Sep 16, 2009

Last updated

Feb 28, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kelly Marie Liedberg Former name

Medicare fee-for-service enrollment

Enrolled in ND, MN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Altru Health SystemGroup PAC ID 1355251604, shared by 14 NPIs, 675 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Altru Dialysis Sat at Mercy Hosp Dialysis facility, Devils Lake, ND, CCN 353506
• Altru Health System Renal Dialysis at Lifecare Dialysis facility, Roseau, MN, CCN 243540
• Altru Health System Renal Dialysis Crookston Dialysis facility, Crookston, MN, CCN 243541
• Altru Hospital Hospital, Grand Forks, ND, CCN 350019
• Lifecare Medical Center Hospital, Roseau, MN, CCN 241344

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Altru Health System

  dba Altru 1300 Columbia

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1043309552
  Medicare reassignment NPD
• Altru Health System

  dba Altru Clinic Crookston

  • Clinic/Center
  • Crookston, MN
  • NPI 1760494330
  Medicare reassignment NPD
• Altru Health System

  dba Altru Care Flight

  • Ambulance
  • Grand Forks, ND
  • NPI 1114485315
  NPD
• Altru Health System

  dba Altru Clinic - East Grand Forks

  • Clinic/Center
  • East Grand Forks, MN
  • NPI 1740621556
  NPD
• Clinic Pharmacy Inc

  • Community/Retail Pharmacy
  • Devils Lake, ND
  • NPI 1184718876
  NPD (past)

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

• Altru Health System

  dba Altru Renal Dialysis Devils Lake

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Devils Lake, ND
  • NPI 1124117692

  Dialysis facility

  Care Compare affiliation Name & address match
• Altru Health System

  dba Altru Health System-Renal Dialysis at Lifecare

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Roseau, MN
  • NPI 1144518549

  Dialysis facility

  Care Compare affiliation Name & address match
• Altru Health System

  dba Altru Health System Renal Dialysis Crookston

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Crookston, MN
  • NPI 1629347489

  Dialysis facility

  Care Compare affiliation Name & address match
• Altru Health System

  • General Acute Care Hospital
  • Grand Forks, ND
  • NPI 1154346161
  Care Compare affiliation
• Lifecare Medical Center

  • Critical Access Hospital
  • Roseau, MN
  • NPI 1609861095
  Care Compare affiliation

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

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551312000000",
    "number": "1972836385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEACH",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-16",
        "last_updated": "2019-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R156241-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R29405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "LIEDBERG",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christine S Lauzon, FNP-C
• Mariah Dawn Laver Juanto, PH.D.
• Alexandra H Lawrence
• Rachel Lawrence
• Briana Coline Lazur
• Amanda Lynn Leavy, PT
• Cindy L Leblanc
• David K Lee
• Lenae Anne Lee, RD, LD
• Menglin Lee

• Family Nurse Practitioner in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Family Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.