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General NPI Number Information
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NPI Number | 1790429504
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Entity Type | Individual
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Provider Name | KELSEY KUIPERS MD
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Gender | Female
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1919 LINCOLN WAY STE 315
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2527
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Country | US
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Telephone | 208-625-6029
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Fax |
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Provider Business Mailing Address
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Address Line | 24589 TIFFANY LN
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City | HERMOSA
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State | SD
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Zip | 57744-7514
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Country | US
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Telephone | 605-391-8310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M-17751
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | M-17751
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License Number State | ID
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