Healthcare Provider Details

I. General information

NPI: 1396665568
Provider Name (Legal Business Name): CASSANDRA MAUGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA HAAS MAUGHAN PMHNP-BC

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S MAIN ST STE 12972
KALISPELL MT
59901-1498
US

IV. Provider business mailing address

1001 S MAIN ST STE 12972
KALISPELL MT
59901-1498
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-7074
  • Fax:
Mailing address:
  • Phone: 406-219-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR-RN-LIC-216784
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-292152
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: