Healthcare Provider Details

I. General information

NPI: 1306262803
Provider Name (Legal Business Name): COTTONWOOD CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MAIN ST
DEER LODGE MT
59722-1000
US

IV. Provider business mailing address

310 MAIN ST
DEER LODGE MT
59722-1000
US

V. Phone/Fax

Practice location:
  • Phone: 406-846-4275
  • Fax: 406-846-7278
Mailing address:
  • Phone: 406-846-4275
  • Fax: 406-846-7278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25000
License Number StateMT

VIII. Authorized Official

Name: HEIDE LYNN APPLEGATE
Title or Position: OWNER, NP
Credential: FNP-C
Phone: 406-846-4275