Individual
MALLERY BUTLER KNOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
350 HERITAGE WAY STE 2100, KALISPELL, MT 59901-3167
(406) 257-8992
(406) 257-8996
Mailing address
6320 N LA CHOLLA BLVD STE 300, TUCSON, AZ 85741-3552
(520) 545-0953
(520) 545-0954
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
7332
AZ
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-103155
MT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/17/2018
Last updated
02/19/2024
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