Healthcare Provider Details

I. General information

NPI: 1790505519
Provider Name (Legal Business Name): STEVI MEADE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E 2ND ST
LIBBY MT
59923-2010
US

IV. Provider business mailing address

2048 AIRPORT RD APT 104
KALISPELL MT
59901-5861
US

V. Phone/Fax

Practice location:
  • Phone: 406-283-6900
  • Fax:
Mailing address:
  • Phone: 406-207-3659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-145755
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: