Provider Demographics
NPI:1386752186
Name:EHRMANTRAUT, KRISTY (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:EHRMANTRAUT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 FOUR MILE DR STE 11
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2663
Mailing Address - Country:US
Mailing Address - Phone:406-609-0210
Mailing Address - Fax:406-609-0211
Practice Address - Street 1:60 FOUR MILE DR STE 11
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2663
Practice Address - Country:US
Practice Address - Phone:406-609-0210
Practice Address - Fax:406-609-0211
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004673363AS0400X
MT620363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT620OtherMONTANA LICENSE
GA004673OtherP.A. LICENSE
MT620OtherMONTANA LICENSE
97WCHJNMedicare ID - Type Unspecified