Healthcare Provider Details

I. General information

NPI: 1972752566
Provider Name (Legal Business Name): JENNIFER LAURA SHIPLEY PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 FOUR MILE DR
KALISPELL MT
59901-7113
US

IV. Provider business mailing address

1995 FOUR MILE DR
KALISPELL MT
59901-7113
US

V. Phone/Fax

Practice location:
  • Phone: 406-261-1847
  • Fax:
Mailing address:
  • Phone: 406-261-1847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number136072
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: