Provider Demographics
NPI:1972522308
Name:TYGRETT-SUE, PATRICIA Y (DO)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:Y
Last Name:TYGRETT-SUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WINDWARD WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3133
Mailing Address - Country:US
Mailing Address - Phone:406-756-8488
Mailing Address - Fax:406-257-4663
Practice Address - Street 1:245 WINDWARD WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3133
Practice Address - Country:US
Practice Address - Phone:406-756-8488
Practice Address - Fax:406-257-4663
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine