Individual
KELLI GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
902 N ORANGE ST, MISSOULA, MT 59802-2928
(406) 329-5736
(406) 329-2941
Mailing address
PO BOX 31001, 4114, PASADENA, CA 91110-4114
(406) 329-5736
(406) 329-2941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-573
MT
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M011004293
MEDICARE PTAN -
MT
Enumeration date
03/20/2009
Last updated
01/30/2026
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