Provider Demographics
NPI:1568886844
Name:FOOTE, KATHRYN ROGOTZKE (FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROGOTZKE
Last Name:FOOTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANNE
Other - Last Name:ROGOTZKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1211 S RESERVE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3103
Mailing Address - Country:US
Mailing Address - Phone:406-327-3057
Mailing Address - Fax:406-327-3231
Practice Address - Street 1:1211 S RESERVE ST STE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3103
Practice Address - Country:US
Practice Address - Phone:406-327-3057
Practice Address - Fax:406-327-3231
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT38612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily