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General NPI Number Information
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NPI Number | 1891159109
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Entity Type | Individual
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Provider Name | KELLY MARIE GREGORY F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 2316 US HIGHWAY 93 N
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City | KALISPELL
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State | MT
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Zip | 59901-2547
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Country | US
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Telephone | 406-755-5661
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Fax | 406-755-5674
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Provider Business Mailing Address
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Address Line | PO BOX 10338
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City | KALISPELL
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State | MT
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Zip | 59904-3338
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Country | US
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Telephone | 406-755-5661
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Fax | 406-755-5674
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NURAPRNLIC102585
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License Number State | MT
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