Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | PAT9113697 | FL |
NPI | 1063012086 |
---|---|
Provider Name | Caitlin Halley Killgore |
First Address | Inverness, FL 34452-6821 |
Second Address | Crystal River, FL 34429-5736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2020 |
Last Update Date | 28/10/2020 |