Provider Demographics
NPI:1053124834
Name:CHRANE, KENDALL BAUER (PA-C)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:BAUER
Last Name:CHRANE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:BAUER
Other - Last Name:PATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2740 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-5135
Mailing Address - Country:US
Mailing Address - Phone:406-728-6010
Mailing Address - Fax:406-721-3278
Practice Address - Street 1:2740 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-5135
Practice Address - Country:US
Practice Address - Phone:406-728-6010
Practice Address - Fax:406-721-3278
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-147737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant