Healthcare Provider Details

I. General information

NPI: 1558116483
Provider Name (Legal Business Name): KATIE KUKOWSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 CENTRAL AVE
BILLINGS MT
59102-6686
US

IV. Provider business mailing address

PO BOX 35100
BILLINGS MT
59107-5100
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number236351
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236351
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: