MEDICARE: FORGED WELLNESS & CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1730013897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORGED WELLNESS & CO

Provider Business Mailing Address
First Line	:	3300 RASER DR
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1534
Country	:	US
Telephone Number	:	406-213-6484
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 RASER DR
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1534
Country	:	US
Telephone Number	:	406-213-6484
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	KATHLEEN RACICOT
Credential	:	PA-C
Telephone Number	:	503-347-1805

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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Directions to “FORGED WELLNESS & CO ” Practice Location

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