Provider Demographics
NPI:1295505865
Name:SCHULTZ, KELLY GUY (PA-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:GUY
Last Name:SCHULTZ
Suffix:
Gender:M
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 1:2313 KISMET CT
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-9073
Mailing Address - Country:US
Mailing Address - Phone:541-324-6113
Mailing Address - Fax:
Practice Address - Street 1:1035 1ST AVE W STE 210
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5607
Practice Address - Country:US
Practice Address - Phone:406-607-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT132226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant