Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | R9F16 | MS |
NPI | 1033108691 |
---|---|
Provider Name | Linza Taylor Killion |
First Address | Sikeston, MO 63801-5046 |
Second Address | Sikeston, MO 63801-5046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
141710 | HEALTHLINK (01) | |
24077 | BLUE CROSS (01) | |
B59430 | (02) |