Healthcare Provider Details

I. General information

NPI: 1487620902
Provider Name (Legal Business Name): PETER KITTS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E 2ND ST
LIBBY MT
59923
US

IV. Provider business mailing address

211 E 2ND ST
LIBBY MT
59923
US

V. Phone/Fax

Practice location:
  • Phone: 406-293-8711
  • Fax: 406-293-8735
Mailing address:
  • Phone: 406-293-8711
  • Fax: 406-293-8735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17575
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: