MEDICARE: MS. KATHLEEN A RUSSELL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN019215	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000370310	OTHER	MT	BCBS

General Provider Information

NPI Number	:	1275631863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN A RUSSELL NP

Provider Business Mailing Address
First Line	:	445 CENTENNIAL AVE
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2870
Country	:	US
Telephone Number	:	406-723-4075
Fax Number	:	406-496-6035

Provider Business Practice Location Address
First Line	:	110 OAK ST
Second Line	:
City	:	ANACONDA
State	:	MT
Zip	:	59711-2335
Country	:	US
Telephone Number	:	406-563-0071
Fax Number	:	406-563-0774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/28/2022

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