Mary C De Souza, MSP ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

101363 Issued in MT

Practice address

343 Sunnyview LN
Kalispell, MT 59901-3156

Phone

(406) 752-1790

Fax

(406) 756-3529

NPI assigned

Oct 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Aware Inc

  • Community/Behavioral Health Agency
  • Anaconda, MT
  • NPI 1427003862
  NPD (past)
• Divide Creek PC

  dba Neal Rogers, MD

  • Otolaryngology Physician
  • Butte, MT
  • NPI 1689884769
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1700972742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 SUNNYVIEW LN",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013156",
            "telephone_number": "406-752-1790",
            "fax_number": "406-756-3529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 SUNNYVIEW LN",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013156",
            "telephone_number": "406-752-1790",
            "fax_number": "406-756-3529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE SOUZA",
        "first_name": "MARY",
        "middle_name": "C",
        "credential": "MSP ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MT",
            "license": "RN26302",
            "primary": false
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "MT",
            "license": "26302",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MT",
            "license": "101363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "343 Sunnyview Ln",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gabriel Dawson, D.D.S.
• Courtney Day, PA-C
• Douglas R Day, PA-C
• Pieter Albert De Lepper, P.T., OCS, CERT. MDT
• Jose C De Souza, MD
• Cindy Jo Dean
• Erika Anne Decree, CRNP
• Rob Degolier, LAC
• Meghan Elizabeth Degroot, FNP-BC
• Thomas A. Dehoop, M.D.

• Adult Health Nurse Practitioner in Kalispell, MT
• Providers in Kalispell, MT by specialty
• Adult Health Nurse Practitioner in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.