Healthcare Provider Details

I. General information

NPI: 1730698952
Provider Name (Legal Business Name): KELLIE LEE ROCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLIE LEE FREEMAN

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 CLINIC RD N
BOX ELDER MT
59521-8849
US

IV. Provider business mailing address

96 CLINIC RD N
BOX ELDER MT
59521-8849
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4486
  • Fax: 406-395-4138
Mailing address:
  • Phone: 406-395-4486
  • Fax: 406-395-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number17988
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: