Provider Demographics
NPI:1427550300
Name:KOLAR, KELLY WOODSIDE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:WOODSIDE
Last Name:KOLAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-8900
Mailing Address - Fax:303-443-6476
Practice Address - Street 1:1645 BROADWAY
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6218
Practice Address - Country:US
Practice Address - Phone:303-415-8900
Practice Address - Fax:303-443-6476
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPA750363A00000X
COPA.0005209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant