=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336248046
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIELY M HOWARD MS, APRN-PMHCNS, BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 09/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N HIGGINS AVE STE 200
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59802-4550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-721-3977
-----------------------------------------------------
Fax | 406-721-3991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8525
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59807-8525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-721-3977
-----------------------------------------------------
Fax | 406-721-3991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0807X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 28149
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------