MEDICARE: KELLY ANN COLOFF

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	363LP0200X	Pediatric Nurse Practitioner	28746	MT
2	363LF0000X	Family Nurse Practitioner	28746	MT

General Provider Information

NPI Number	:	1205094398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN COLOFF

Provider Business Mailing Address
First Line	:	734 9TH ST W STE 12
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-3858
Country	:	US
Telephone Number	:	406-892-1011
Fax Number	:

Provider Business Practice Location Address
First Line	:	734 9TH ST W STE 12
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-3858
Country	:	US
Telephone Number	:	406-892-1011
Fax Number	:

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

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	04/24/2013

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Directions to “ KELLY ANN COLOFF ” Practice Location

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