Provider Demographics
NPI:1134212277
Name:FOUHY-THURSTON, MARY KAY (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:FOUHY-THURSTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-3401
Mailing Address - Country:US
Mailing Address - Phone:406-388-8708
Mailing Address - Fax:406-388-8710
Practice Address - Street 1:403 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3401
Practice Address - Country:US
Practice Address - Phone:406-388-8708
Practice Address - Fax:406-388-8710
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN9447363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4308344Medicaid
MT810542541OtherCOMMERCIAL
MT810542541OtherCOMMERCIAL
Q65838Medicare UPIN
MT011001631Medicare PIN