Provider Demographics
NPI:1699702100
Name:BRONSON, KATHY JEAN (FNPC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JEAN
Last Name:BRONSON
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 INDIAN TRAIL RD STE 2
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2613
Mailing Address - Country:US
Mailing Address - Phone:406-755-6774
Mailing Address - Fax:406-257-2706
Practice Address - Street 1:95 INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2613
Practice Address - Country:US
Practice Address - Phone:406-755-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN25228163WG0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTS81119Medicare UPIN