Healthcare Provider Details

I. General information

NPI: 1609673136
Provider Name (Legal Business Name): CARI DOUGLASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 HARMON STREAM BLVD STE 101
BOZEMAN MT
59718-4097
US

IV. Provider business mailing address

1707 WYATT EARP CT
BELGRADE MT
59714-1115
US

V. Phone/Fax

Practice location:
  • Phone: 406-312-8360
  • Fax:
Mailing address:
  • Phone: 406-274-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-172671
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: