Provider Demographics
NPI:1699938613
Name:MCCOLLY, KRISTIN KELLIE (NP-C)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:KELLIE
Last Name:MCCOLLY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:MT
Mailing Address - Zip Code:59241-0002
Mailing Address - Country:US
Mailing Address - Phone:406-648-5432
Mailing Address - Fax:406-648-5430
Practice Address - Street 1:724 4TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:MT
Practice Address - Zip Code:59241
Practice Address - Country:US
Practice Address - Phone:406-648-5432
Practice Address - Fax:406-648-5430
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT100454363LF0000X, 363LP0808X
NDR5006363LF0000X, 363LP0808X
MT26721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT9902750Medicaid