Healthcare Provider Details

I. General information

NPI: 1730403502
Provider Name (Legal Business Name): KATIE KIDWELL D'ARDENNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE SUSANNA KIDWELL MD

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 ALASKA FRONTAGE RD
BELGRADE MT
59714-7909
US

IV. Provider business mailing address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-3334
  • Fax:
Mailing address:
  • Phone: 406-414-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMED-PHYS-LIC-58170
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: