Provider Demographics
NPI:1356142574
Name:CLOS, KARRY MIKEL (LPN)
Entity type:Individual
Prefix:
First Name:KARRY
Middle Name:MIKEL
Last Name:CLOS
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 WINNE AVE # A1
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4958
Mailing Address - Country:US
Mailing Address - Phone:406-422-0114
Mailing Address - Fax:
Practice Address - Street 1:2625 WINNE AVE # A1
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4958
Practice Address - Country:US
Practice Address - Phone:406-422-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-LPN-LIC-98484164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse