Provider Demographics
NPI:1619546942
Name:CHRISTOPHER, KELSEY
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70192 MARTZ DR
Mailing Address - Street 2:
Mailing Address - City:ARLEE
Mailing Address - State:MT
Mailing Address - Zip Code:59821-9068
Mailing Address - Country:US
Mailing Address - Phone:406-370-2080
Mailing Address - Fax:
Practice Address - Street 1:70192 MARTZ DR
Practice Address - Street 2:
Practice Address - City:ARLEE
Practice Address - State:MT
Practice Address - Zip Code:59821-9068
Practice Address - Country:US
Practice Address - Phone:406-370-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program