Individual
MS. KELSEY GRACE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
601 W SPRUCE ST STE K, MISSOULA, MT 59802-4047
(406) 327-1950
Mailing address
PO BOX 31001, PASADENA, CA 91110-4110
(406) 327-1950
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MED-PAC-LIC-34912
MT
363AM0700X
Medical Physician Assistant
—
OR
Other
Enumeration date
09/24/2007
Last updated
12/09/2025
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