Healthcare Provider Details

I. General information

NPI: 1891159109
Provider Name (Legal Business Name): KELLY MARIE GREGORY F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 US HIGHWAY 93 N
KALISPELL MT
59901-2547
US

IV. Provider business mailing address

PO BOX 10338
KALISPELL MT
59904-3338
US

V. Phone/Fax

Practice location:
  • Phone: 406-755-5661
  • Fax: 406-755-5674
Mailing address:
  • Phone: 406-755-5661
  • Fax: 406-755-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNURAPRNLIC102585
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: