Healthcare Provider Details

I. General information

NPI: 1013834233
Provider Name (Legal Business Name): FULL CUP MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 VILLAGE LOOP RD
KALISPELL MT
59901-2793
US

IV. Provider business mailing address

50 VILLAGE LOOP RD
KALISPELL MT
59901-2793
US

V. Phone/Fax

Practice location:
  • Phone: 406-755-3196
  • Fax: 406-858-9081
Mailing address:
  • Phone: 406-755-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HALEY PETERS
Title or Position: FAMILY NURSE PRACTITIONER
Credential:
Phone: 406-871-9987