Provider Demographics
NPI:1568469765
Name:KELLEY, DENISE CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:CHRISTINE
Last Name:KELLEY
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:CHRISTINE
Other - Last Name:TUTTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4 HOLIDAY LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1432
Mailing Address - Country:US
Mailing Address - Phone:406-529-0684
Mailing Address - Fax:
Practice Address - Street 1:4 HOLIDAY LN
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1432
Practice Address - Country:US
Practice Address - Phone:406-529-0684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072853L207Q00000X
MT146675208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050121Medicare ID - Type Unspecified
PAH45476Medicare UPIN