Healthcare Provider Details

I. General information

NPI: 1114093077
Provider Name (Legal Business Name): KIMBERLY ELLINGSON KOTUR APRN-BC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTH 7TH AVE SWINGLE STUDENT HEALTH SERVICE
BOZEMAN MT
59717-3260
US

IV. Provider business mailing address

PO BOX 173260 SWINGLE STUDENT HEALTH SERVICE SOUTH 7TH AVE
BOZEMAN MT
59717-3260
US

V. Phone/Fax

Practice location:
  • Phone: 406-994-2311
  • Fax: 406-994-2504
Mailing address:
  • Phone: 406-994-2311
  • Fax: 406-994-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN10809
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: