Provider Demographics
NPI:1427414440
Name:HASKELL, KARA (PA-C)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:HASKELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:PERRINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 ELLIS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8813
Mailing Address - Country:US
Mailing Address - Phone:406-587-0122
Mailing Address - Fax:
Practice Address - Street 1:1450 ELLIS ST
Practice Address - Street 2:#201
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-587-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical