Healthcare Provider Details

I. General information

NPI: 1447363916
Provider Name (Legal Business Name): MARY C VELK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 FORT MISSOULA RD STE 202
MISSOULA MT
59804-7424
US

IV. Provider business mailing address

126 6TH AVE SW
RONAN MT
59864-2600
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-4292
  • Fax: 406-728-5770
Mailing address:
  • Phone: 406-676-3600
  • Fax: 406-676-3738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number372
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: