Healthcare Provider Details

I. General information

NPI: 1407631799
Provider Name (Legal Business Name): KELLY ANN BOURGEOIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6102 JOHANNS MEADOW LN
BILLINGS MT
59101-7168
US

IV. Provider business mailing address

6102 JOHANNS MEADOW LN
BILLINGS MT
59101-7168
US

V. Phone/Fax

Practice location:
  • Phone: 406-461-9180
  • Fax:
Mailing address:
  • Phone: 406-461-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-292870
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number176733
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: