Provider Demographics
NPI:1174675128
Name:ESHLEMAN, JOY A (PAC)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:A
Last Name:ESHLEMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:WORDEN
Mailing Address - State:MT
Mailing Address - Zip Code:59088-0246
Mailing Address - Country:US
Mailing Address - Phone:406-967-2255
Mailing Address - Fax:406-967-2251
Practice Address - Street 1:2469 MAIN ST
Practice Address - Street 2:
Practice Address - City:WORDEN
Practice Address - State:MT
Practice Address - Zip Code:59088-2227
Practice Address - Country:US
Practice Address - Phone:406-967-2255
Practice Address - Fax:406-967-2251
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0432956OtherMDCD PIN
MT000091473OtherBCBS PIN
MT0432956OtherMDCD PIN
MT000091473OtherBCBS PIN
MTS49563Medicare UPIN