Provider Demographics
NPI:1932233632
Name:PELLETT, KATHERINE M (APRN, NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:PELLETT
Suffix:
Gender:F
Credentials:APRN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 4TH ST S
Mailing Address - Street 2:COMMUNITY HEALTH CARE CENTER
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3618
Mailing Address - Country:US
Mailing Address - Phone:406-454-6973
Mailing Address - Fax:
Practice Address - Street 1:115 4TH ST S
Practice Address - Street 2:COMMUNITY HEALTH CARE CENTER
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3618
Practice Address - Country:US
Practice Address - Phone:406-454-6973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24541363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT374680OtherBCBS MT
MT9971418Medicaid
S31560Medicare UPIN
271815Medicare ID - Type UnspecifiedCLINIC'S MEDICARE ID