Individual
MS. KELLY POLUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
610 N CALIFORNIA ST, MISSOULA, MT 59802-3950
(406) 721-1646
(406) 543-9890
Mailing address
610 N CALIFORNIA ST, MISSOULA, MT 59802-3950
(406) 721-1646
(406) 543-9890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
397
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4304604
—
MT
Enumeration date
09/15/2006
Last updated
10/07/2021
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