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General NPI Number Information
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NPI Number | 1043090921
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Entity Type | Individual
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Provider Name | JEFFRY PHILLIP KOLBUS DNP, APRN, AGPCNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 2074 S 6TH ST
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-3372
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Country | US
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Telephone | 541-851-8110
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Fax | 541-851-8114
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Provider Business Mailing Address
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Address Line | 2074 S 6TH ST
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-3372
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Country | US
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Telephone | 541-851-8110
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Fax | 541-851-8114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 28231833A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71015599A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 10036424
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License Number State | OR
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