Provider Demographics
NPI:1821670142
Name:GEARHART, ALI (PMH NP-BC)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:GEARHART
Suffix:
Gender:F
Credentials:PMH NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 VALLEY COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5661
Mailing Address - Country:US
Mailing Address - Phone:406-471-6419
Mailing Address - Fax:
Practice Address - Street 1:3950 VALLEY COMMONS DR STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5662
Practice Address - Country:US
Practice Address - Phone:406-471-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-174103363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health