Kelly Marie Leach, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Grand Forks, ND
NPI 1972836385 · NPPES record last updated Feb 28, 2019
Key facts
- NPI
- 1972836385
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R29405 (ND)
- Practice address
- 1300 S Columbia Rd
Grand Forks, ND 58201 - Phone
- (701) 780-2300
- NPI assigned
- Sep 16, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Altru Health System
Practice addresses (Care Compare)
1001 7TH St NE
Devils Lake, ND 58301-2719
Phone (701) 662-2157
1200 S Columbia Rd
Grand Forks, ND 58201-4036
Phone (701) 780-5000
1300 S Columbia Rd
Grand Forks, ND 58201-4012
Phone (701) 780-5000
1380 S Columbia Rd
Grand Forks, ND 58201-4059
Phone (701) 795-2000
400 S Minnesota St
Crookston, MN 56716-1808
Phone (218) 281-9100
Hospital & facility affiliations
- Altru Dialysis Sat at Mercy Hosp
- Altru Health System Renal Dialysis at Lifecare
- Altru Health System Renal Dialysis Crookston
- Altru Hospital
- Lifecare Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091125000608 | ND | Practitioner - Nurse Practitioner | 9931248218 | Reassigns benefits to 1 organization |
| I20150303000846 | MN | Practitioner - Nurse Practitioner | 9931248218 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R156241-1 | MN | MD | Family Nurse Practitioner |
| R29405 | ND | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Altru Health System | Current |
Accepting new patients | |
| Altru Health System | Current | Accepting new patients | |
| Altru Health System | Current |
Accepting new patients | |
| Altru Health System | Current | Accepting new patients | |
| Clinic Pharmacy Inc | Past | Accepting new patients |
Locations
400 S Minnesota St
Crookston, MN 56716
Phone (218) 281-9100
607 Demers Ave
East Grand Forks, MN 56721
Phone (218) 773-0357
19120 200th St
Greenbush, MN 56726
Phone (218) 782-2400
711 Delmore Dr
Roseau, MN 56751
Phone (218) 463-1365
412 Main Ave NE
Warroad, MN 56763
Phone (218) 386-2020
201 E 3rd Ave S
Cavalier, ND 58220
Phone (701) 265-8338
1001 7th St NE
Devils Lake, ND 58301
Phone (701) 662-2157
1380 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 795-2000
2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891
1000 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 780-5089
1300 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 780-2300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R156241-1 | MN | |
| Family Nurse Practitioner | 363LF0000X | R29405 | ND | Yes |
Addresses
Primary practice location
1300 S Columbia Rd
Grand Forks, ND 58201
Mailing address
2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891
Other names
- Kelly Marie Liedberg
Other providers in Grand Forks, ND
- Christine S Lauzon
- Mariah Dawn Laver Juanto
- Alexandra H Lawrence
- Rachel Lawrence
- Briana Coline Lazur
- Amanda Lynn Leavy
- Cindy L Leblanc
- Lenae Anne Lee
- Menglin Lee
- Michael Lee
All providers in Grand Forks, ND · Family Nurse Practitioner in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.