Healthcare Provider Details

I. General information

NPI: 1114543386
Provider Name (Legal Business Name): CHEYENNE JAE FELTZ PMHNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 MONTANA AVE E
BIG SANDY MT
59520-7754
US

IV. Provider business mailing address

PO BOX 1391
FORT BENTON MT
59442-1391
US

V. Phone/Fax

Practice location:
  • Phone: 406-378-2189
  • Fax: 406-378-2180
Mailing address:
  • Phone: 505-362-8212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-217333
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: