Healthcare Provider Details

I. General information

NPI: 1407807373
Provider Name (Legal Business Name): KRISTEN ELLEN DARLING-GREEN CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. KRISTEN ELLEN DARLING

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HERITAGE WAY
KALISPELL MT
59901-3191
US

IV. Provider business mailing address

160 HERITAGE WAY
KALISPELL MT
59901-3191
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-8330
  • Fax: 406-752-8412
Mailing address:
  • Phone: 406-752-8330
  • Fax: 406-752-8412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1054
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: