Healthcare Provider Details

I. General information

NPI: 1144100892
Provider Name (Legal Business Name): SCOTT A BRADY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HERITAGE WAY STE 202
KALISPELL MT
59901-3127
US

IV. Provider business mailing address

4634 US HIGHWAY 93 S
WHITEFISH MT
59937-8404
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-8433
  • Fax: 406-756-6768
Mailing address:
  • Phone: 406-606-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-268658
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: