Provider Demographics
NPI:1467475079
Name:SMITH-KEIL, TERESA D (FNP-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:SMITH-KEIL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CHOTEAU
Mailing Address - State:MT
Mailing Address - Zip Code:59422-9123
Mailing Address - Country:US
Mailing Address - Phone:406-466-5763
Mailing Address - Fax:406-466-5842
Practice Address - Street 1:915 4TH ST NW
Practice Address - Street 2:
Practice Address - City:CHOTEAU
Practice Address - State:MT
Practice Address - Zip Code:59422-9123
Practice Address - Country:US
Practice Address - Phone:406-466-5763
Practice Address - Fax:406-466-5842
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22046.0304363LF0000X
MT14907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY121007600Medicaid
MT456807Medicaid
WY313564OtherINDIVIDUAL BLUE CROSS NUM