Provider Demographics
NPI:1720416068
Name:MILANI, KELLYN ALISON (ND)
Entity Type:Individual
Prefix:DR
First Name:KELLYN
Middle Name:ALISON
Last Name:MILANI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 CABALLO AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5657
Mailing Address - Country:US
Mailing Address - Phone:406-624-6824
Mailing Address - Fax:
Practice Address - Street 1:2291 CABALLO AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5657
Practice Address - Country:US
Practice Address - Phone:406-624-6824
Practice Address - Fax:406-548-9755
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-NAT-LIC-979175F00000X
CAND717175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath