Individual
KATHERINE A TETRAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
600 MT HIGHWAY 91 S, DILLON, MT 59725-7379
(406) 683-3051
Mailing address
244 TUKE LN, TWIN BRIDGES, MT 59754-9735
(406) 925-9707
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085003834
IL
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-18647
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MED-PAC-LIC-18647
STATE OF MONTANA PHYSICIAN ASSISTANT LICENSE
MT
Enumeration date
09/10/2010
Last updated
06/29/2021
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