Provider Demographics
NPI:1073164257
Name:STERRY, KAITLYN ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ROSE
Last Name:STERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LOOKING EAST DR
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:MT
Mailing Address - Zip Code:59932-9707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3120
Practice Address - Country:US
Practice Address - Phone:406-758-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant