Provider Demographics
NPI:1336248046
Name:HOWARD, KIELY M (MS, APRN-PMHCNS, BC)
Entity Type:Individual
Prefix:
First Name:KIELY
Middle Name:M
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MS, APRN-PMHCNS, BC
Other - Prefix:
Other - First Name:KIELY
Other - Middle Name:M
Other - Last Name:CROCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8525
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-8525
Mailing Address - Country:US
Mailing Address - Phone:406-721-3977
Mailing Address - Fax:406-721-3991
Practice Address - Street 1:500 N HIGGINS AVE STE 200
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4550
Practice Address - Country:US
Practice Address - Phone:406-721-3977
Practice Address - Fax:406-721-3991
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT28149364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT374830OtherBCBS
MT4306224Medicaid