Provider Demographics
NPI:1295090983
Name:ADDISON, KARA MARIE (DNP-C)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:ADDISON
Suffix:
Gender:F
Credentials:DNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 FRONT STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3442
Mailing Address - Country:US
Mailing Address - Phone:406-820-3376
Mailing Address - Fax:406-312-1611
Practice Address - Street 1:920 FRONT STREET SUITE 103
Practice Address - Street 2:SUITE 103
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3442
Practice Address - Country:US
Practice Address - Phone:406-820-3376
Practice Address - Fax:406-312-1611
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-100802363L00000X
MT2680189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTI-750624Medicaid