Healthcare Provider Details

I. General information

NPI: 1962849067
Provider Name (Legal Business Name): KELLY IRONS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W PENNSYLVANIA AVE
ANACONDA MT
59711-1900
US

IV. Provider business mailing address

401 W PENNSYLVANIA AVE
ANACONDA MT
59711-1999
US

V. Phone/Fax

Practice location:
  • Phone: 406-563-8686
  • Fax: 406-563-8691
Mailing address:
  • Phone: 406-563-8500
  • Fax: 406-563-8694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number78401
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number78401
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number78401
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: