=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578951307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIG SKY PSYCHIATRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2015
-----------------------------------------------------
Last Update Date | 06/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2735 COLONIAL DR STE A
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59601-4971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-204-2151
-----------------------------------------------------
Fax | 406-204-2154
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2735 COLONIAL DR STE A
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59601-4971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-204-2151
-----------------------------------------------------
Fax | 406-204-2154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. KRISTA DAVID
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 406-204-2151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MED-PHYS-LIC-10752
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------