Healthcare Provider Details

I. General information

NPI: 1689977175
Provider Name (Legal Business Name): KELSEY A. BOCK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 25TH ST S
GREAT FALLS MT
59405-5183
US

IV. Provider business mailing address

1401 25TH ST S
GREAT FALLS MT
59405-5183
US

V. Phone/Fax

Practice location:
  • Phone: 406-731-8888
  • Fax: 406-731-8318
Mailing address:
  • Phone: 406-731-8888
  • Fax: 406-731-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number637
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: