Provider Demographics
NPI:1548618747
Name:CHAPPELL, KATHRYN ANNA (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNA
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 S 4TH ST E APT 204
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1002
Mailing Address - Country:US
Mailing Address - Phone:406-459-9530
Mailing Address - Fax:
Practice Address - Street 1:2837 FORT MISSOULA RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7408
Practice Address - Country:US
Practice Address - Phone:063-273-9114
Practice Address - Fax:406-327-3919
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT103201363LF0000X
OR201907060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily