Healthcare Provider Details

I. General information

NPI: 1225283153
Provider Name (Legal Business Name): KELLY WHETSTONE WILLIAMS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY WHETSTONE

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 BROOKS ST STE 101
MISSOULA MT
59801-7338
US

IV. Provider business mailing address

4200 INCLINATION WAY
MISSOULA MT
59803-9708
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax:
Mailing address:
  • Phone: 253-370-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60048667
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number143462
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: