Katherine A Tetrault, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MED-PAC-LIC-18647 Issued in MT

Practice address

600 Mt Highway 91 S
Dillon, MT 59725-7379

Phone

(406) 683-3051

NPI assigned

Sep 10, 2010

Last updated

Jun 29, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ktetrault783746@wm.providencedirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Barrett Hospital Development Corporation

  dba Barrett Hospital & HealthCare

  • Critical Access Hospital
  • Dillon, MT
  • NPI 1326042078
  Medicare reassignment NPD
• Barrett Hospital Development Corporation

  • Critical Access Hospital
  • Dillon, MT
  • NPI 1396286480
  Medicare reassignment NPD
• St Peters Community Hospital

  dba St Peters Urgent Care

  • Multi-Specialty Clinic/Center
  • Helena, MT
  • NPI 1033354683
  Medicare reassignment NPD
• Lewis and Clark Emergency Physicians P C

  • Emergency Medicine Physician
  • Helena, MT
  • NPI 1083668651
  Medicare reassignment
• Barrett Hospital Development Corporation

  dba Barrett Hospital Clinic Twin Bridges

  • Multi-Specialty Clinic/Center
  • Twin Bridges, MT
  • NPI 1265319255
  NPD
• St. Peter's Health

  dba Sound Health Imaging

  • Radiology Clinic/Center
  • Butte, MT
  • NPI 1194785154
  NPD
• Barrett Hospital Development Corporation

  • Medicare Defined Swing Bed Hospital Unit
  • Dillon, MT
  • NPI 1326419102
  NPD (past)
• Heartcare Midwest

  • Rural Acute Care Hospital
  • Bloomington, IL
  • NPI 1477782845
  NPD (past)
• Heartcare Midwest , LTD

  dba OSF Medical Group-HeartCare Midwest

  • Cardiovascular Disease Physician
  • Peoria, IL
  • NPI 1720023179
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1306153432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 TUKE LN",
            "city": "TWIN BRIDGES",
            "state": "MT",
            "postal_code": "597549735",
            "telephone_number": "406-925-9707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MT HIGHWAY 91 S",
            "city": "DILLON",
            "state": "MT",
            "postal_code": "597257379",
            "telephone_number": "406-683-3051"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "321 Madison St",
            "address_purpose": "LOCATION",
            "city": "Sheridan",
            "state": "MT",
            "postal_code": "597499636",
            "country_code": "US",
            "telephone_number": "406-842-5453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TETRAULT",
        "first_name": "KATHERINE",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-10",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003834",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "MED-PAC-LIC-18647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MONTANA PHYSICIAN ASSISTANT LICENSE",
            "identifier": "MED-PAC-LIC-18647",
            "state": "MT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KTETRAULT783746@WM.PROVIDENCEDIRECT.ORG",
            "affiliation": "N",
            "address_1": "600 Mt Highway 91 S",
            "city": "Dillon",
            "state": "MT",
            "country_code": "US",
            "postal_code": "597257379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stoic Minds, PLLC
• Sunnyside Therapy PLLC
• Sweet Medicine Therapy LLC
• Sweetwater Dillon Opco LLC (Parkview Nursing and Rehabilitation)
• Kymberly M Tart, PA-C
• The Legacy Assisted Living LLC
• The Notch PT and Wellness LLC
• Tara Marie Thompson, DPT
• Thrive and Grow Speech Therapy, PLLC
• Hallie Ann Kerins Tipton, MD

• Physician Assistant in Dillon, MT
• Providers in Dillon, MT by specialty
• Physician Assistant in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.