Healthcare Provider Details

I. General information

NPI: 1528358363
Provider Name (Legal Business Name): KATHERINE M HASTINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 S RESERVE ST SUITE101
MISSOULA MT
59801-3102
US

IV. Provider business mailing address

1211 S RESERVE ST SUITE101
MISSOULA MT
59801-3102
US

V. Phone/Fax

Practice location:
  • Phone: 840-632-7305
  • Fax: 406-327-3231
Mailing address:
  • Phone: 840-632-7305
  • Fax: 406-327-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMED-PHYS-LIC-49926
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: