Healthcare Provider Details

I. General information

NPI: 1063594182
Provider Name (Legal Business Name): KEVEN JEAN COMER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 HIGHLAND BLVD STE 5410
BOZEMAN MT
59715-6916
US

IV. Provider business mailing address

925 HIGHLAND BLVD STE 1100
BOZEMAN MT
59715-6900
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-2400
  • Fax:
Mailing address:
  • Phone: 406-582-8957
  • Fax: 406-585-3028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN15042
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: