=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801299466
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELSEY O'NEILL RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2014
-----------------------------------------------------
Last Update Date | 09/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 HERITAGE WAY STE 1100
-----------------------------------------------------
City | KALISPELL
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59901-3160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-752-8900
-----------------------------------------------------
Fax | 406-752-8909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 13TH AVE S STE 106
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59405-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-455-2841
-----------------------------------------------------
Fax | 406-455-2842
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | MED-NUTR-LIC-34641
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------