Provider Demographics
NPI:1386303212
Name:WOLFE, KIMBERLY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:SCOBEY
Mailing Address - State:MT
Mailing Address - Zip Code:59263-0416
Mailing Address - Country:US
Mailing Address - Phone:406-783-7436
Mailing Address - Fax:
Practice Address - Street 1:105 5TH AVE E
Practice Address - Street 2:
Practice Address - City:SCOBEY
Practice Address - State:MT
Practice Address - Zip Code:59263-7849
Practice Address - Country:US
Practice Address - Phone:406-487-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT187294363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health