Provider Demographics
NPI:1770659518
Name:HANSEN, KATHRYN KAY (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KAY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 COMMONS LOOP
Mailing Address - Street 2:STE 300
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-756-7555
Mailing Address - Fax:406-756-7517
Practice Address - Street 1:175 COMMONS LOOP
Practice Address - Street 2:STE 300
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-756-7555
Practice Address - Fax:406-756-7517
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7521207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT00031031Medicaid
F30723Medicare UPIN
MT00081730Medicare PIN