Provo, Kristene A
Provo, Kristene A is an individual health care provider with primary practice located at 2835 Fort Missoula Road , Missoula MT 59804-7408. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Provo, Kristene A can be contacted via phone (406) 721-5600.Contact Information
Primary practice address
2835 Fort Missoula Road
Missoula MT 59804-7408
Phone: (406) 721-5600
Fax: (406) 721-3907
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 126 | Montana |
Profile Details
| NPI number | 1528002821 |
|---|---|
| LBN Legal business name | Provo, Kristene A |
| Credentials | PAC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 16th, 2006 |
| Last updated | Feb 29th, 2024 - about 9 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528002821 | NPPES |
| Montana | MEDICAID | 0435676 |
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