| Kalispel Indian Community Of The Kalispel Reservation Washington | |
|
1821 Leclerc Rd N Cusick WA 99119-9682 | |
| (509) 447-7111 | |
| Not Available |
| Full Name | Kalispel Indian Community Of The Kalispel Reservation Washington |
|---|---|
| Speciality | General Practice |
| Location | 1821 Leclerc Rd N, Cusick, Washington |
| Authorized Official Name and Position | Clayton Kersting (DIRECTOR OF MEDICAL SERVICES) |
| Authorized Official Contact | 5094477111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kalispel Indian Community Of The Kalispel Reservation Washington Po Box 67 Cusick WA 99119-0067 Ph: (509) 447-7111 | Kalispel Indian Community Of The Kalispel Reservation Washington 1821 Leclerc Rd N Cusick WA 99119-9682 Ph: (509) 447-7111 |
| NPI Number | 1396937769 |
|---|---|
| Provider Enumeration Date | 08/09/2007 |
| Last Update Date | 12/16/2025 |
| Medicare PECOS PAC ID | 1951498922 |
|---|---|
| Medicare Enrollment ID | O20071107000736 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396937769 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261QH0100X | Clinic/center - Health Service | (* (Not Available)) | Secondary |
| Provider Name | Angelika B Kraus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801988902 PECOS PAC ID: 6507837721 Enrollment ID: I20040803000151 |
| Provider Name | Ryan A Leisy |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1982741195 PECOS PAC ID: 4880797182 Enrollment ID: I20070306000716 |
| Provider Name | Lora L Jasman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821197740 PECOS PAC ID: 8628165586 Enrollment ID: I20071025000085 |
| Provider Name | Kimberlyn A Johnstone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528128907 PECOS PAC ID: 7618051327 Enrollment ID: I20080219000697 |
| Provider Name | Clayton W Kersting |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962594234 PECOS PAC ID: 8527955244 Enrollment ID: I20100701000754 |
| Provider Name | Hilary Hopkins |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1467834614 PECOS PAC ID: 8820307515 Enrollment ID: I20160519002193 |
| Provider Name | Annette C Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235565805 PECOS PAC ID: 7517271570 Enrollment ID: I20190201002579 |
| Provider Name | Kimberly Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851308191 PECOS PAC ID: 5698796563 Enrollment ID: I20190225001817 |
| Provider Name | Jennifer Marie Tackitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730667833 PECOS PAC ID: 1951641752 Enrollment ID: I20190313002817 |
| Provider Name | Krystina Felix |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689049132 PECOS PAC ID: 4486058187 Enrollment ID: I20210805001496 |
| Provider Name | Jaime Hopoi |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1083384119 PECOS PAC ID: 1658760301 Enrollment ID: I20220119000770 |
| Provider Name | Annie Frederick |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1205093911 PECOS PAC ID: 2365890233 Enrollment ID: I20231204000619 |
| Provider Name | Anita Toyo Waterman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487212239 PECOS PAC ID: 3274075981 Enrollment ID: I20240610003189 |