Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 200000243 | NC |
NPI | 1417979501 |
---|---|
Provider Name | Jefferson Kirby Kilpatrick |
First Address | Pinehurst, NC 28374 |
Second Address | Pinehurst, NC 28374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 06/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89126AH | (05) | NC |
G95852 | (02) | NC |