Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 0099-00899 | NC |
NPI | 1063421345 |
---|---|
Provider Name | Dr. Stephen Downer Kicklighter |
First Address | Raleigh, NC 27604-0010 |
Second Address | Raleigh, NC 27610-1231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 03/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
891209Y | (05) | NC |
G29177 | (02) |