Healthcare Provider Details

I. General information

NPI: 1063585594
Provider Name (Legal Business Name): LAURA WINSTEAD PRATT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MONTANA CENTER, 245 WINDWARD WAY STE101
KALISPELL MT
59901-3133
US

IV. Provider business mailing address

431 SENDERO DR
KALISPELL MT
59901-7154
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-8488
  • Fax: 406-257-4663
Mailing address:
  • Phone: 406-257-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18072
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11220
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: