Provider Demographics
NPI:1053146662
Name:KILLEBREW, ANGELA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KILLEBREW
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 WHISPER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-7611
Mailing Address - Country:US
Mailing Address - Phone:602-531-0624
Mailing Address - Fax:
Practice Address - Street 1:2400 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6563
Practice Address - Country:US
Practice Address - Phone:406-723-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT236353363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology