Lakeside Wellness PC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

10172 Issued in MT

Legal business name

LAKESIDE WELLNESS PC

Practice address

77 Deer CR Rd
Suite B
Somers, MT 59932

Phone

(406) 755-3751

NPI assigned

Nov 15, 2013

Organization subpart

No

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

Authorized official

Name

Ms. Jill B Ripley, FNP

Title

Owner

Phone

(406) 755-3751

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1384473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1306276035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 848",
            "city": "LAKESIDE",
            "state": "MT",
            "postal_code": "599220848",
            "telephone_number": "406-755-3751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 DEER CR RD",
            "address_2": "SUITE B",
            "city": "SOMERS",
            "state": "MT",
            "postal_code": "59932",
            "telephone_number": "406-755-3751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE WELLNESS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-15",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "RIPLEY",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-755-3751",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MT",
            "license": "10172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Lynn Davies
• Evoke Changes LLC
• Valerie A Goss, NBC-HWC
• Suzanne C Gullotta, APRN
• Lakeside Clinic P.C.
• Myia L Powers, L.C.S.W.
• Suzanne C Gullotta (Lakeside Family Health Center)
• Ariane Nicole Waller, LCSW

• Health Service Clinic/Center in Somers, MT
• Providers in Somers, MT by specialty
• Health Service Clinic/Center in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.