Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2016-02211 | NC |
N | 207QS0010X | Family Doctor - Sports Medicine | M0131 | TX |
NPI | 1134175227 |
---|---|
Provider Name | Dr. Virginia Reed Killoren |
First Address | Matthews, NC 28105-6640 |
Second Address | Matthews, NC 28105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 31/12/2018 |