MEDICARE: ANGELA KILLEBREW NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	236353	MT

General Provider Information

NPI Number	:	1053146662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA KILLEBREW NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	383 WHISPER RIDGE RD
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-7611
Country	:	US
Telephone Number	:	602-531-0624
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 VETERANS CIR
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-7536
Country	:	US
Telephone Number	:	406-792-3100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	04/09/2026

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