Organization Active NPI

Ava Health LLC

  • Family Nurse Practitioner
  • Missoula, MT
National Provider Identifier
1548740822
Registry record updated Sep 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
131528 Issued in MT
Legal business name
AVA HEALTH LLC
Practice address
2875 Tina Ave Ste 107
Missoula, MT 59808-1582
Phone
(406) 544-0628
Fax
(406) 302-0899
NPI assigned
Aug 16, 2018
Last updated
Sep 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2022

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

Authorized official

Name
Michelle Weaver Knowles, FNPNPI 1205313590
Title
Owner/FNP
Phone
(406) 544-0628

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 131528 MT Primary

Addresses

Primary practice location

2875 Tina Ave Ste 107
Missoula, MT 59808-1582

Mailing address

2875 Tina Ave Ste 107
Missoula, MT 59808-1582
Phone (406) 544-0628

Other identifiers 1

IdentifierTypeStateIssuer
1205313590OtherMTINDIVIDUAL NPI NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181022001446 MT Part B Supplier - Clinic/Group Practice 7810240843 Receives reassigned benefits from 1 practitioner
Practice locations: Missoula, MT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D2230364Ava Health LLC2875 Tina Avenue, Suite 102a, Missoula, MT 59808Certificate of waiverJul 21, 2027

National Provider Directory

National Provider Directory

Locations

1001 E Broadway St
#2
Missoula, MT 59802

2825 Fort Missoula Rd
Ste 113
Missoula, MT 59804
Phone (406) 542-2116

2875 Tina Ave
Ste 102A
Missoula, MT 59808

2875 Tina Ave
Ste 107
Missoula, MT 59808
Phone (406) 544-0628

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1534377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663200000000",
    "number": "1548740822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2875 TINA AVE STE 107",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081582",
            "telephone_number": "406-544-0628",
            "fax_number": "406-302-0899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 TINA AVE STE 107",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081582",
            "telephone_number": "406-544-0628",
            "fax_number": "406-302-0899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-16",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A",
        "authorized_official_last_name": "WEAVER KNOWLES",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER/FNP",
        "authorized_official_telephone_number": "406-544-0628",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MT",
            "license": "131528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1205313590",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.