=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922650290
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER L MCANALLY APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2019
-----------------------------------------------------
Last Update Date | 05/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1643 24TH ST W STE 210
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-2677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-431-1336
-----------------------------------------------------
Fax | 406-831-5090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1643 24TH ST W STE 210
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-2677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-431-1336
-----------------------------------------------------
Fax | 406-831-5090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 145850
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | NUR-APRN-LIC-145850
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------