Provider Demographics
NPI:1457807323
Name:STAEBLER, KAITLIN REUSS (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:REUSS
Last Name:STAEBLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:BRAUN
Other - Last Name:REUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3737 GRAND AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6258
Mailing Address - Country:US
Mailing Address - Phone:406-839-2985
Mailing Address - Fax:406-839-2986
Practice Address - Street 1:3737 GRAND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6258
Practice Address - Country:US
Practice Address - Phone:406-839-2985
Practice Address - Fax:406-239-2986
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X, 363A00000X
MT51053364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health