Provider Demographics
NPI:1255300851
Name:CHILD, KENDALL A (CNP)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:A
Last Name:CHILD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N WILLSON
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3572
Mailing Address - Country:US
Mailing Address - Phone:406-587-0681
Mailing Address - Fax:406-587-9011
Practice Address - Street 1:931 HIGHLAND BLVD STE 3130
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6914
Practice Address - Country:US
Practice Address - Phone:406-414-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN32019363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT370341OtherBCBS
MT4307715Medicaid
MTQ66925Medicare UPIN