Healthcare Provider Details

I. General information

NPI: 1144528258
Provider Name (Legal Business Name): KRISTINE MARIE LIPPERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINE M CROWELL PA-C

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 N. 29TH STREET
BILLINGS MT
59101
US

IV. Provider business mailing address

1041 N. 29TH STREET
BILLINGS MT
59101
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-5577
  • Fax: 406-237-5575
Mailing address:
  • Phone: 406-237-5577
  • Fax: 406-237-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number654
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: