Provider Demographics
NPI:1730120858
Name:SMITH, JUDITH NEAL (FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:NEAL
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JUDITY
Other - Middle Name:ELAINE
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1012 8TH STREET EAST
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937
Mailing Address - Country:US
Mailing Address - Phone:406-862-4821
Mailing Address - Fax:
Practice Address - Street 1:2181 HWY 2, EAST
Practice Address - Street 2:SUITE 9
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-756-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24990363L00000X
MTNUR-APRN-LIC-100356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT373090OtherBLUE CROSS
MT4306263Medicaid
MT4306263Medicaid
MT84803Medicare ID - Type Unspecified