Healthcare Provider Details

I. General information

NPI: 1003596578
Provider Name (Legal Business Name): LAUREL CASIMIRA WINSOR BARBER MSHI, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREL CASIMIRA BARBER

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 N 15TH AVE STE 1
BOZEMAN MT
59715-3290
US

IV. Provider business mailing address

1188 N 15TH AVE STE 1
BOZEMAN MT
59715-3290
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-2620
  • Fax: 406-219-5536
Mailing address:
  • Phone: 406-586-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMED-PAC-LIC-131074
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: