Healthcare Provider Details

I. General information

NPI: 1366424558
Provider Name (Legal Business Name): JESSIE LYN KAUTZMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S ALABAMA ST STE 6A
BUTTE MT
59701-2358
US

IV. Provider business mailing address

401 W PENNSYLVANIA AVE STE 300
ANACONDA MT
59711-1999
US

V. Phone/Fax

Practice location:
  • Phone: 406-563-7239
  • Fax: 406-782-2890
Mailing address:
  • Phone: 406-563-8500
  • Fax: 406-563-8694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10036
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10036
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: