Healthcare Provider Details

I. General information

NPI: 1689431900
Provider Name (Legal Business Name): KRISTEN PYKE-PIERCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35401 MISSION DR
SAINT IGNATIUS MT
59865-7791
US

IV. Provider business mailing address

35401 MISSION DR
SAINT IGNATIUS MT
59865-7791
US

V. Phone/Fax

Practice location:
  • Phone: 406-745-3525
  • Fax: 406-226-2645
Mailing address:
  • Phone: 406-745-3525
  • Fax: 406-226-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-PSY-LIC-5059
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: