Healthcare Provider Details

I. General information

NPI: 1861368920
Provider Name (Legal Business Name): KYLE SANBORN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 WINGS WAY BUILDING HANGAR 77
BELGRADE MT
59714
US

IV. Provider business mailing address

205 N PONDERA AVE APT C
BOZEMAN MT
59718-6392
US

V. Phone/Fax

Practice location:
  • Phone: 503-678-4364
  • Fax:
Mailing address:
  • Phone: 603-502-7851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License NumberNUR-RN-LIC-236119
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: