Provider Demographics
NPI:1255827242
Name:SHOWALTER, KERRY LYNN
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:LYNN
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13405 TURAH RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MT
Mailing Address - Zip Code:59825-9776
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13405 TURAH RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MT
Practice Address - Zip Code:59825-9776
Practice Address - Country:US
Practice Address - Phone:406-529-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer