Provider Demographics
NPI:1942764873
Name:EUWEMA, KELLY MICHELE (DNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MICHELE
Last Name:EUWEMA
Suffix:
Gender:F
Credentials:DNP-BC
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:MICHELE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP-BC
Mailing Address - Street 1:915 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6902
Mailing Address - Country:US
Mailing Address - Phone:406-414-5000
Mailing Address - Fax:
Practice Address - Street 1:1805 OAK ST STE 3
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8847
Practice Address - Country:US
Practice Address - Phone:406-414-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-143356363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1942764873Medicaid