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NPI Code Detail

MEDICARE: DR. CLARE KELLY MD

MEDICARE: DR. CLARE KELLY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1538721725
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLARE KELLY MD
Provider Business Mailing Address
First Line : 401 RAILROAD ST W
Second Line :
City : MISSOULA
State : MT
Zip : 59802-4178
Country : US
Telephone Number : 406-258-4789
Fax Number : 406-258-4732
Provider Business Practice Location Address
First Line : 401 RAILROAD ST W
Second Line :
City : MISSOULA
State : MT
Zip : 59802-4178
Country : US
Telephone Number : 406-258-4789
Fax Number : 406-258-4732
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2019
Last Update Date : 04/02/2024

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