Active NPI
Laira L Fonner
- Psychiatric/Mental Health Nurse Practitioner
- Missoula, MT
National Provider Identifier
1902645286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- NUR-APRN-LIC-240866
- Practice address
- 2431 River Rd
Missoula, MT 59804-1239 - Phone
- (406) 361-5093
- NPI assigned
- May 24, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | NUR-APRN-LIC-240866 | MT | Primary |
Addresses
Primary practice location
2431 River Rd
Missoula, MT 59804-1239
Mailing address
328 3Rd St W
Whitefish, MT 59937-3017
Phone (406) 890-8767
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NUR-APRN-LIC-240866 | MT | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726185600000",
"number": "1902645286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "328 3RD ST W",
"city": "WHITEFISH",
"state": "MT",
"postal_code": "599373017",
"telephone_number": "406-890-8767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2431 RIVER RD",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598041239",
"telephone_number": "406-361-5093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONNER",
"first_name": "LAIRA",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-24",
"last_updated": "2024-09-13",
"certification_date": "2024-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "MT",
"license": "NUR-APRN-LIC-240866",
"primary": true
}
],
"identifiers": [],
"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 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.