Basic Information
| Provider Information | |||||||||
| NPI: | 1528132651 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDING | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3075 N RESERVE ST | ||||||||
| Address2: | SUITE Q | ||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598081389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063271850 | ||||||||
| FaxNumber: | 4063271875 | ||||||||
| Practice Location | |||||||||
| Address1: | 3075 N RESERVE ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598081389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063271850 | ||||||||
| FaxNumber: | 4063271875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 20476 | MT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | NUR-APRN-LIC-100368 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1528132651 | 05 | MT | MEDICAID |