Healthcare Provider Details

I. General information

NPI: 1285569103
Provider Name (Legal Business Name): KELSAY HANNAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

IV. Provider business mailing address

2446 NORTHVIEW ST
BOZEMAN MT
59715-2141
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-2325
  • Fax:
Mailing address:
  • Phone: 515-473-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number232431
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: