Healthcare Provider Details

I. General information

NPI: 1134212277
Provider Name (Legal Business Name): MARY KAY FOUHY-THURSTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W MAIN ST
BELGRADE MT
59714-3401
US

IV. Provider business mailing address

403 W MAIN ST
BELGRADE MT
59714-3401
US

V. Phone/Fax

Practice location:
  • Phone: 406-388-8708
  • Fax: 406-388-8710
Mailing address:
  • Phone: 406-388-8708
  • Fax: 406-388-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN9447
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: