Healthcare Provider Details

I. General information

NPI: 1780623181
Provider Name (Legal Business Name): BRENDA KIRKLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N 10TH ST STE A
HAMILTON MT
59840-2318
US

IV. Provider business mailing address

330 N 10TH ST STE A
HAMILTON MT
59840-2318
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-3627
  • Fax:
Mailing address:
  • Phone: 406-363-3627
  • Fax: 406-237-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9923
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: