Provider Demographics
NPI:1831149269
Name:KELLY, PATRICIA ANNE (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6011
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-6011
Mailing Address - Country:US
Mailing Address - Phone:406-541-1400
Mailing Address - Fax:406-541-1401
Practice Address - Street 1:2419 MULLAN RD STE A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1856
Practice Address - Country:US
Practice Address - Phone:406-541-1400
Practice Address - Fax:406-514-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11020207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E67163Medicare UPIN