Provider Demographics
NPI:1003549478
Name:BAKKER, TIA
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:BAKKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 SHERMAN LN
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6057
Mailing Address - Country:US
Mailing Address - Phone:406-260-1072
Mailing Address - Fax:
Practice Address - Street 1:200 COMMONS WAY STE B
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1915
Practice Address - Country:US
Practice Address - Phone:406-752-5170
Practice Address - Fax:406-752-5210
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT160698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant