NPIMap

Individual provider Active NPI

Nichole Marie McKinsey, D,O,

  • Family Medicine Physician
  • Polson, MT
National Provider Identifier
1790046035
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
41009 Issued in MT
Practice address
6 13TH Ave E
Polson, MT 59860
Phone
(406) 883-5680
Fax
(406) 883-8910
NPI assigned
Jun 4, 2012
Last updated
Jan 26, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 41009 MT Primary

Addresses

Primary practice location

6 13TH Ave E
Polson, MT 59860

Mailing address

PO Box 31001
4114
Pasadena, CA 91110-4114
Phone (406) 883-5680

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nmckinsey535222@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150716001715 MT Practitioner - Family Practice 6800109075 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6 13TH Ave E
Polson, MT 59860-5315
Phone (406) 883-5377

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
41009MTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake County CurrentSince Oct 1, 2016 Accepting new patients
Providence St Joseph Medical Center CurrentSince Jan 26, 2026 Accepting new patients

Locations

6 13th Ave E
Polson, MT 59860
Phone (406) 883-5377

802 Main St
Ste A
Polson, MT 59860
Phone (406) 883-7288

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769385600000",
    "number": "1790046035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001",
            "address_2": "4114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104114",
            "telephone_number": "406-883-5680",
            "fax_number": "406-883-8910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 13TH AVE E",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "59860",
            "telephone_number": "406-883-5680",
            "fax_number": "406-883-8910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINSEY",
        "first_name": "NICHOLE",
        "middle_name": "MARIE",
        "credential": "D,O,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-04",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "41009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nmckinsey535222@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "6 13th Ave E",
            "city": "Polson",
            "state": "MT",
            "country_code": "US",
            "postal_code": "59860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Polson, MT

Sources for this page

Verify at the official NPI Registry.