Provider Demographics
NPI:1083670285
Name:THOMASCLARK, HEATHER KRISTINE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:KRISTINE
Last Name:THOMASCLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 SUNNYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3156
Mailing Address - Country:US
Mailing Address - Phone:406-752-1790
Mailing Address - Fax:406-756-3529
Practice Address - Street 1:343 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3156
Practice Address - Country:US
Practice Address - Phone:406-752-1790
Practice Address - Fax:406-756-3529
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI732363LF0000X
MT47021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN