1114093077 NPI number — MRS. KIMBERLY ELLINGSON KOTUR APRN-BC FNP

Table of content: MRS. KIMBERLY ELLINGSON KOTUR APRN-BC FNP (NPI 1114093077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114093077 NPI number — MRS. KIMBERLY ELLINGSON KOTUR APRN-BC FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOTUR
Provider First Name:
KIMBERLY
Provider Middle Name:
ELLINGSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114093077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 173260
Provider Second Line Business Mailing Address:
SWINGLE STUDENT HEALTH SERVICE SOUTH 7TH AVE
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59717-3260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-994-2311
Provider Business Mailing Address Fax Number:
406-994-2504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SOUTH 7TH AVE
Provider Second Line Business Practice Location Address:
SWINGLE STUDENT HEALTH SERVICE
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59717-3260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-994-2311
Provider Business Practice Location Address Fax Number:
406-994-2504
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN10809 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com