Healthcare Provider Details

I. General information

NPI: 1083670285
Provider Name (Legal Business Name): HEATHER KRISTINE THOMASCLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/27/2023
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 SUNNYVIEW LN
KALISPELL MT
59901-3156
US

IV. Provider business mailing address

343 SUNNYVIEW LN
KALISPELL MT
59901-3156
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-1790
  • Fax: 406-756-3529
Mailing address:
  • Phone: 406-752-1790
  • Fax: 406-756-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number732
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number47021
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: