Healthcare Provider Details

I. General information

NPI: 1427101856
Provider Name (Legal Business Name): JULIE RENEE KELSO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE KELSO HEGGEM MD

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S 27TH ST
BILLINGS MT
59101-4227
US

IV. Provider business mailing address

123 S 27TH ST
BILLINGS MT
59101-4227
US

V. Phone/Fax

Practice location:
  • Phone: 406-247-3350
  • Fax: 406-247-3389
Mailing address:
  • Phone: 406-247-3350
  • Fax: 406-247-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11489
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: