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General NPI Number Information
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NPI Number | 1104648211
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL MEDICINE ASSOCIATES OF MONTANA
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 195 COMMONS LOOP STE D
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City | KALISPELL
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State | MT
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Zip | 59901-1912
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Country | US
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Telephone | 406-501-6570
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Fax |
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Provider Business Mailing Address
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Address Line | 195 COMMONS LOOP STE D
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City | KALISPELL
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State | MT
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Zip | 59901-1912
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Country | US
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Telephone | 406-501-6570
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER/CO-OWNER
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Name | BRITTANY JEAN COBURN
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Credential | NP-C
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Telephone | 406-501-6570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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