Provider Demographics
NPI:1912778523
Name:CHEFF, JESSIE BRYSTOL (AGNP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:BRYSTOL
Last Name:CHEFF
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59851-0400
Mailing Address - Country:US
Mailing Address - Phone:406-239-5536
Mailing Address - Fax:
Practice Address - Street 1:103 PONTIAC ST
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:MT
Practice Address - Zip Code:59851-6503
Practice Address - Country:US
Practice Address - Phone:406-239-5536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-234066363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner