Provider Demographics
NPI:1790041309
Name:KULBECK, KRYSTYL L (PA-C)
Entity Type:Individual
Prefix:
First Name:KRYSTYL
Middle Name:L
Last Name:KULBECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530
Mailing Address - Street 2:166 MONTANA AVE E
Mailing Address - City:BIG SANDY
Mailing Address - State:MT
Mailing Address - Zip Code:59520-0530
Mailing Address - Country:US
Mailing Address - Phone:406-378-2189
Mailing Address - Fax:406-378-2180
Practice Address - Street 1:166 MONTANA AVE E
Practice Address - Street 2:
Practice Address - City:BIG SANDY
Practice Address - State:MT
Practice Address - Zip Code:59520
Practice Address - Country:US
Practice Address - Phone:406-378-2189
Practice Address - Fax:406-378-2180
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24305363A00000X
OH50-003506363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical