Individual
KENNETH KESSLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
500 W BROADWAY ST, MISSOULA, MT 59802-4008
(406) 329-5615
(406) 329-5606
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(406) 329-5615
(406) 329-5606
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA187906
OR
363AS0400X
Surgical Physician Assistant
Primary
MED-PAC-LIC-42349
MT
363AS0400X
Surgical Physician Assistant
PAC0184
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538250246
NPI
—
01
—
P00271582
RAILROAD MEDICARE
ND
Enumeration date
09/27/2006
Last updated
10/25/2021
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