Healthcare Provider Details

I. General information

NPI: 1558483206
Provider Name (Legal Business Name): HKJ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 CEDAR ST
MISSOULA MT
59802-3911
US

IV. Provider business mailing address

1120 CEDAR ST
MISSOULA MT
59802-3911
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-1929
  • Fax:
Mailing address:
  • Phone: 406-543-1929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number10966
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number12957
License Number StateMT

VIII. Authorized Official

Name: MRS. DONNA ROSE JENNINGS
Title or Position: PRESIDENT
Credential:
Phone: 406-541-4673