MEDICARE: CHERRY CREEK AESTHETICS, LLC

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

General Provider Information

NPI Number	:	1881521615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHERRY CREEK AESTHETICS, LLC

Provider Business Mailing Address
First Line	:	271 CUT ACROSS RD
Second Line	:
City	:	GLASGOW
State	:	MT
Zip	:	59230-2806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 1ST AVE S
Second Line	:
City	:	GLASGOW
State	:	MT
Zip	:	59230-2310
Country	:	US
Telephone Number	:	406-263-8552
Fax Number	:

Authorized Official
Title or Position	:	OWNER, AESTHETIC NURSE PRACTITIONER
Name	:	MRS. KARA MEGHAN KNODEL
Credential	:	FNP-C
Telephone Number	:	406-263-8552

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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