Provider Demographics
NPI:1609058411
Name:STUDINER, KIMBERLY DAWN (PA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:STUDINER
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:PO BOX 70
Mailing Address - Street 2:420 CHEYENNE AVE
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043
Mailing Address - Country:US
Mailing Address - Phone:406-477-4554
Mailing Address - Fax:406-477-3153
Practice Address - Street 1:420 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043
Practice Address - Country:US
Practice Address - Phone:406-477-4554
Practice Address - Fax:406-477-4554
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT517OtherSTATE LICENSE
MT9901939Medicaid