Healthcare Provider Details

I. General information

NPI: 1396937769
Provider Name (Legal Business Name): KALISPEL INDIAN COMMUNITY OF THE KALISPEL RESERVATION WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 LECLERC RD N
CUSICK WA
99119-9682
US

IV. Provider business mailing address

PO BOX 67
CUSICK WA
99119-0067
US

V. Phone/Fax

Practice location:
  • Phone: 509-447-7111
  • Fax:
Mailing address:
  • Phone: 509-447-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CLAYTON KERSTING
Title or Position: DIRECTOR OF MEDICAL SERVICES
Credential: M.D.
Phone: 509-447-7111