Provider Demographics
NPI:1457828238
Name:DEMARAIS, KATIE (PA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:DEMARAIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0731
Mailing Address - Country:US
Mailing Address - Phone:406-237-5577
Mailing Address - Fax:406-237-5575
Practice Address - Street 1:1041 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0731
Practice Address - Country:US
Practice Address - Phone:406-237-5577
Practice Address - Fax:406-237-5575
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant