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General NPI Number Information
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NPI Number | 1790179448
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Entity Type | Individual
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Provider Name | COLLEEN ANNE KILCULLEN NP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 2101 KEN PRATT BLVD STE 104A
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City | LONGMONT
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State | CO
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Zip | 80501-6568
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Country | US
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Telephone | 303-415-4155
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Fax | 303-776-3109
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Provider Business Mailing Address
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Address Line | PO BOX 9049
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City | BOULDER
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State | CO
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Zip | 80301-9049
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Country | US
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Telephone | 303-415-4155
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Fax | 303-776-3109
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APN.0091467
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APN.0091467-NP
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License Number State | CO
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