Healthcare Provider Details

I. General information

NPI: 1679283915
Provider Name (Legal Business Name): STILLWATER HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 PECAN DR STE C
PADUCAH KY
42001-6717
US

IV. Provider business mailing address

546 US HIGHWAY 93 N STE A
EUREKA MT
59917-9053
US

V. Phone/Fax

Practice location:
  • Phone: 270-519-6655
  • Fax:
Mailing address:
  • Phone: 406-610-0700
  • Fax: 406-610-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURA BAILEY
Title or Position: PRACTICE ADMINISTRATOR
Credential: RN
Phone: 270-442-3535