MEDICARE: JILLIAN CULLISON PA-C

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	363A00000X	Physician Assistant	107835	MT

General Provider Information

NPI Number	:	1659794618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN CULLISON PA-C

Provider Business Mailing Address
First Line	:	75 CLAREMONT ST STE H
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3500
Country	:	US
Telephone Number	:	406-752-7406
Fax Number	:	406-752-7544

Provider Business Practice Location Address
First Line	:	75 CLAREMONT ST STE H
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3500
Country	:	US
Telephone Number	:	406-752-7406
Fax Number	:	406-752-7544

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

Provider Enumeration Date	:	01/28/2014
Last Update Date	:	03/05/2025

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