Healthcare Provider Details

I. General information

NPI: 1174081723
Provider Name (Legal Business Name): SARI REY KERSLAKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2019
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MAIN ST
STEVENSVILLE MT
59870-2846
US

IV. Provider business mailing address

PO BOX 31001-4110
PASADENA CA
91110-4110
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-5522
  • Fax: 406-777-1175
Mailing address:
  • Phone: 406-777-5522
  • Fax: 406-777-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number143817
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number143817
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: