Provider Demographics
NPI:1205858867
Name:SCHMIDT, BROOKE KENDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:KENDRA
Last Name:SCHMIDT
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 1:1600 WHITEFISH STAGE STE 1
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2172
Mailing Address - Country:US
Mailing Address - Phone:406-314-4477
Mailing Address - Fax:
Practice Address - Street 1:1600 WHITEFISH STAGE STE 1
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2172
Practice Address - Country:US
Practice Address - Phone:406-314-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0294363AM0700X
MT27751363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P96801Medicare UPIN
NDN23443Medicare PIN
ND71129Medicaid