Provider Demographics
NPI:1952395758
Name:COLLEDGE, PAULA S (PA-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:S
Last Name:COLLEDGE
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 1:500 WEST BROADWAY STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4012
Mailing Address - Country:US
Mailing Address - Phone:406-728-6520
Mailing Address - Fax:406-329-2936
Practice Address - Street 1:500 WEST BROADWAY STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4012
Practice Address - Country:US
Practice Address - Phone:406-728-6520
Practice Address - Fax:406-329-2936
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT355363A00000X
MTMED-PAC-LIC-355363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4302632Medicaid
MTQ03678Medicare UPIN
MT4302632Medicaid