Healthcare Provider Details

I. General information

NPI: 1477497568
Provider Name (Legal Business Name): CARLY NICOLE KEIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLY NICOLE TROGSTAD

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LINCOLN WAY STE 315
COEUR D ALENE ID
83814-2527
US

IV. Provider business mailing address

3227 S 74TH ST W
BILLINGS MT
59106-4104
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-6000
  • Fax:
Mailing address:
  • Phone: 360-463-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: