KRISTENE A PROVO (NPI# 1528002821) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528002821 |
| Entity Type | Individual |
| Full Name | KRISTENE A PROVO |
| Credential | PAC |
| Practice Address |
2835 Fort Missoula Road Missoula MT 59804-7408 |
| Mailing Address |
Po Box 7609 Missoula MT 59807-7609 |
| Practice Telephone | 4067215600 |
| Practice Fax Number | 4067213907 |
| Mailing Telephone | 4067215600 |
| Mailing Fax Number | 4067213907 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
126 | MT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | 0435676 | 05 |
| Street Address |
2835 FORT MISSOULA ROAD |
| City | MISSOULA |
| State | MT |
| Zip Code | 59804-7408 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841247467 | Dirk R Gottman | Pediatrics | 2835 Fort Missoula Road, Missoula, MT 59804-7408 | 2006-05-28 |
| 1144230368 | Anne Manktelow | Surgery | 2835 Fort Missoula Road, Ste 306 Pediatric Surgery of Montana, Missoula, MT 59804 | 2006-08-09 |
| 1255361499 | Georgia G Maynard | Nurse Practitioner | 2835 Fort Missoula Road, Missoula, MT 59804-7408 | 2006-07-04 |
| 1346281359 | Lindsay A Richards | Obstetrics & Gynecology | 2835 Fort Missoula Road, Missoula, MT 59804-7408 | 2006-06-09 |
| 1457391203 | Eric J Kress | Family Medicine | 2835 Fort Missoula Road, Missoula, MT 59804-7408 | 2006-06-08 |
| 1235179508 | Kathleen S Rogers | Pediatrics | 2835 Fort Missoula Road, Missoula, MT 59804-7408 | 2006-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063019297 | Momentum Speech Therapy, PC | Speech-Language Pathologist | 9885 O'brien Creek Road, Missoula, MT 59804 | 2020-10-01 |
| 1033633037 | Marissa Clark | Genetic Counselor, MS | 2827 Fort Missoula Rd., Suite 317, Missoula, MT 59804 | 2017-08-01 |
| 1104295245 | Scott Richter | Specialist/Technologist | 2892 Ringo Dr, Missoula, MT 59804 | 2015-09-18 |
| 1467860353 | Zachary Ueland | Pharmacist | 4000 Highway 93 South, Missoula, MT 59804 | 2014-07-24 |
| 1316378185 | Tracy Laurel Brothers | Counselor | 1305 Wyoming Street, Missoula, MT 59804 | 2013-12-04 |
| 1447683651 | Granite Pharmacy Missoula, LLC | Durable Medical Equipment & Medical Supplies | 2230 27th Ave. West, Suite 2, Missoula, MT 59804 | 2013-08-12 |
| 1871843953 | Autum Emerson Howell | Nurse Practitioner | 2831 Ft. Missoula Rd. Bldg 2, 102, Missoula, MT 59804 | 2012-09-14 |
| 1821353939 | Carlyn Doyle | Nurse Practitioner | 2835 Fort Missoula Rd Ste 203, Missoula, MT 59804 | 2012-07-05 |
| 1396011961 | Patricia Jean Evans | Internal Medicine | 702 S.w. Higgins, First Choice Medical Clinic, Missoula, MT 59804 | 2012-03-28 |
| 1205126794 | Pacific Medical, Inc. | Prosthetic/Orthotic Supplier | 2732 South Ave West, Suite 202, Missoula, MT 59804 | 2011-04-18 |
| Find all providers in zip 59804 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114015617 | Keri F Allmacher | Physician Assistant | 1821 South Ave W, Ste 402, Missoula, MT 59801-6517 | 2006-10-10 |
| 1043215221 | Ruth M West | Physician Assistant | 900 N Orange St, Suite #207, Missoula, MT 59802-2998 | 2005-06-15 |
| 1205468725 | Stephanie Elizabeth Carl | Physician Assistant | 500 W Broadway St, Missoula, MT 59802-4008 | 2020-02-12 |
| 1831582568 | Brianna Lui | Physician Assistant | 900 N Orange St, Suite 303, Missoula, MT 59802-2998 | 2015-03-04 |
| 1972994739 | Heidi Maria Meierbachtol | Physician Assistant | 500 W Broadway St, Suite 320, Missoula, MT 59802-4008 | 2015-02-13 |
| 1124422506 | Andrew David Ashford | Physician Assistant | 500 W Broadway St, Missoula, MT 59802-4008 | 2014-10-14 |
| 1538584958 | Alira N Spring | Physician Assistant | 1821 South Ave W Ste 402, Missoula, MT 59801-6518 | 2014-02-21 |
| 1649509506 | Winslow Lewis IIi | Physician Assistant | 323 W Alder St, Missoula, MT 59802-4123 | 2009-12-23 |
| 1518296672 | Elizabeth A. Mcneece | Physician Assistant | 900 N Orange St Ste 202, Missoula, MT 59802-2951 | 2009-12-18 |
| 1548594591 | Lynn Marie Graham | Physician Assistant | 2825 Fort Missoula Rd, Suite 130, Missoula, MT 59804-7420 | 2009-09-23 |
| Find all providers in MISSOULA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.