Provider Demographics
NPI:1811098981
Name:JORGENSEN, KATHY PALM (APRN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:PALM
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 4TH AVENUE NORTH
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101
Mailing Address - Country:US
Mailing Address - Phone:406-248-3637
Mailing Address - Fax:406-254-9330
Practice Address - Street 1:211 9TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401
Practice Address - Country:US
Practice Address - Phone:406-454-3431
Practice Address - Fax:406-454-3433
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN11415363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT432848Medicaid
37003OtherBCBS
MT80693Medicare ID - Type UnspecifiedFEDERAL CMS
S60381Medicare UPIN