OIG exclusion detail
KELLY ETZEL
This page shows an imported LEIE row. Verify details against the official OIG source before acting.
Imported OIG rowOfficial OIG source
- NPI
- 1639285281
- Name
- KELLY R ETZEL
- Address
- 5804 LEGEND LANE, LOLO, MT, 59847
- Specialty
- PHYSICIAN ASSISTANT
- Exclusion type
- 1128a4
- Exclusion date
- 20170420
- Reinstatement date
- 00000000
- Waiver
- 00000000
Source snapshot
Imported: May 05, 2026
Rows: 83,001
Checksum: 3a10b8ee0e4691855f74ce65a5e733672474291f79ed1f7cef163328d945e9a7
Open matching NPI page