Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 223215 | AZ |
NPI | 1033678297 |
---|---|
Provider Name | Mrs. Christina Kilgore |
First Address | Chandler, AZ 85224-2879 |
Second Address | Chandler, AZ 85224-2879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2019 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN188141 | RN (01) | AZ |