Healthcare Provider Details

I. General information

NPI: 1356420863
Provider Name (Legal Business Name): KATHLEEN A DOLEZAL APRN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 HELENA AVE
HELENA MT
59601-3654
US

IV. Provider business mailing address

616 HELENA AVE STE 301
HELENA MT
59601-3654
US

V. Phone/Fax

Practice location:
  • Phone: 406-495-7220
  • Fax:
Mailing address:
  • Phone: 406-442-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number17403
License Number StateMT

VIII. Authorized Official

Name: NAOMI POCKLINGTON
Title or Position: MANAGER, BILLING COMPANY
Credential:
Phone: 866-602-6822