Provider Demographics
NPI:1528358363
Name:HASTINGS, KATHERINE M
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:HASTINGS
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 1:1211 S RESERVE ST
Mailing Address - Street 2:SUITE101
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3102
Mailing Address - Country:US
Mailing Address - Phone:840-632-7305
Mailing Address - Fax:406-327-3231
Practice Address - Street 1:1211 S RESERVE ST
Practice Address - Street 2:SUITE101
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3102
Practice Address - Country:US
Practice Address - Phone:840-632-7305
Practice Address - Fax:406-327-3231
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-49926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine