Provider Demographics
NPI:1447546601
Name:TIPTON, HALLIE ANN KERINS (MD)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:ANN KERINS
Last Name:TIPTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:ANN
Other - Last Name:KERINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:30 MT HIGHWAY 91 S
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3535
Mailing Address - Country:US
Mailing Address - Phone:406-683-1188
Mailing Address - Fax:
Practice Address - Street 1:30 MT HIGHWAY 91 S
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3535
Practice Address - Country:US
Practice Address - Phone:406-683-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6086207Q00000X
MT33364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT33364OtherMT STATE BOARD OF MEDICAL EXAMINERS
AKMD9635Medicaid
AKMD9635Medicaid