Healthcare Provider Details

I. General information

NPI: 1639897044
Provider Name (Legal Business Name): DARBY BETTENHAUSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 MAIN ST
COLSTRIP MT
59323-9520
US

IV. Provider business mailing address

6230 MAIN ST
COLSTRIP MT
59323-9520
US

V. Phone/Fax

Practice location:
  • Phone: 406-748-3600
  • Fax:
Mailing address:
  • Phone: 406-748-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-144710
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: