Provider Demographics
NPI:1225587355
Name:DEXTER, KATHERINE (DNP, APRN-BC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DEXTER
Suffix:
Gender:F
Credentials:DNP, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 GREAT NORTHERN LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1750
Mailing Address - Country:US
Mailing Address - Phone:406-541-3046
Mailing Address - Fax:406-543-0740
Practice Address - Street 1:2819 GREAT NORTHERN LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1750
Practice Address - Country:US
Practice Address - Phone:406-541-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID54187363LF0000X
MT104697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily