Healthcare Provider Details

I. General information

NPI: 1598837270
Provider Name (Legal Business Name): DIEDRA BETHUNE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. DIEDRA BETHUNE HOYT

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 EAST MAIN ST
MISSOULA MT
59802
US

IV. Provider business mailing address

2525 4TH AVENUE NORTH SUITE 201
BILLINGS MT
59101
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-5490
  • Fax: 406-728-5497
Mailing address:
  • Phone: 406-248-3637
  • Fax: 406-254-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN11641
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: