DR. KELLY CRAGHILL FAGERBURG SMITH (NPI# 1376896803) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376896803 |
| Entity Type | Individual |
| Full Name | DR. KELLY CRAGHILL FAGERBURG SMITH |
| Credential | PSYD |
| Practice Address |
1308 23rd St S Fargo ND 58103-3707 |
| Practice Telephone | 7012977540 |
| Practice Fax Number | 7012976439 |
| Mailing Telephone | 7012977540 |
| Mailing Fax Number | 7012976439 |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2015-03-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 473 | ND | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
473 | ND | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 17313 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518566371 | Kelly Rae Smith | Nurse Practitioner | 13402 Creekview Rd, Prospect, KY 40059-9028 | 2020-10-22 |
| 1447877899 | Kelly Smith | Dental Hygienist | 7700 Sw Garden Home Rd Apt 24, Portland, OR 97223-7496 | 2020-07-01 |
| 1346720893 | Kelly Smith | Licensed Vocational Nurse | 512 S Kearny, Clarendon, TX 79226 | 2018-08-15 |
| 1568976751 | Kelly Elizabeth Smith | Counselor | 216 Gilmer Street, Lebanon, VA 24266 | 2017-11-27 |
| 1013437870 | Kelly Dennis Smith | Public Health or Welfare | 211 Oakmont Dr, New Orleans, LA 70128-3624 | 2017-06-22 |
| 1164955498 | Kelly Ghislaine Smith | Student in an Organized Health Care Education/Training Program | 171 Old Chester Rd, Essex Fells, NJ 07021-1624 | 2017-04-04 |
| 1588026975 | Kelly Therese Smith | Specialist/Technologist | 344 S Maple Ave #2a, Oak Park, IL 60302 | 2016-03-24 |
| 1790168326 | Kelly Smith | Counselor | 545 Sw 26th St, Oklahoma City, OK 73109-6740 | 2015-07-01 |
| 1518353341 | Kelly Smith | Nurse Practitioner | 2232 Wilborn Ave Ste D, South Boston, VA 24592-1662 | 2015-04-08 |
| 1265830491 | Kelly Sue Smith | Speech-Language Pathologist | 210 Starpine Pl Unit A, Prescott, AZ 86303-7017 | 2014-12-22 |
| Street Address |
1308 23RD ST S |
| City | FARGO |
| State | ND |
| Zip Code | 58103-3707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114949773 | Eileen Stone | Psychologist | 1308 23rd St S, Fargo, ND 58103 | 2006-07-24 |
| 1104389550 | Erika Lane Sorensen | Counselor | 1308 23rd St S, Fargo, ND 58103-3707 | 2019-04-11 |
| 1477709574 | Benson Psychological Services PC | Community/Behavioral Health | 1308 23rd St S, Suite G, Fargo, ND 58103-3707 | 2008-08-08 |
| 1174698641 | Lynne M Flanders | Social Worker | 1308 23rd St S, Suite G, Fargo, ND 58103-3707 | 2006-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
| Find all providers in zip 58103 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366067084 | Minela Zornic | Psychologist | 204 24th St S Apt 210, Fargo, ND 58103-1350 | 2020-06-09 |
| 1518240332 | Erica R Hoff | Psychologist | 505 40th St. S., Suite 505a, Fargo, ND 58103 | 2011-09-28 |
| 1538399019 | Kristilynn Cedars | Psychologist | 5225 23rd Ave S Route 4712, Fargo, ND 58122-4712 | 2009-07-20 |
| 1982707543 | David Jerome Hartson | Psychologist | 1517 32nd Ave S, Fargo, ND 58103-5905 | 2006-09-07 |
| 1255449989 | Sara D Quam | Psychologist | 3220 18th St S, Ste 4, Fargo, ND 58104-6564 | 2006-08-25 |
| 1114949773 | Eileen Stone | Psychologist | 1308 23rd St S, Fargo, ND 58103 | 2006-07-24 |
| 1215982319 | Jackson William Lind | Psychologist | 100 4th St. S #302, Fargo, ND 58103 | 2006-05-24 |
| 1720622822 | Nicole Marie Justice | Psychologist | 2101 Elm St N, Fargo, ND 58102-2417 | 2019-10-31 |
| 1386186211 | Katie Nylander | Psychologist | 3401 45th St S, Fargo, ND 58104 | 2016-11-09 |
| 1770930273 | Megan L Spencer | Psychologist | 1702 University Dr S, Fargo, ND 58103-4940 | 2016-05-16 |
| Find all providers in FARGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.