Provider Demographics
NPI:1891159109
Name:GREGORY, KELLY MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:FNP
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 10338
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-3338
Mailing Address - Country:US
Mailing Address - Phone:406-755-5661
Mailing Address - Fax:406-755-5674
Practice Address - Street 1:2316 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2547
Practice Address - Country:US
Practice Address - Phone:406-755-5661
Practice Address - Fax:406-755-5674
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNURAPRNLIC102585363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner