1508882184 NPI number — MS. COLLEEN MARCIA KILGORE FNP APRN BC

Table of content: MS. COLLEEN MARCIA KILGORE FNP APRN BC (NPI 1508882184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508882184 NPI number — MS. COLLEEN MARCIA KILGORE FNP APRN BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILGORE
Provider First Name:
COLLEEN
Provider Middle Name:
MARCIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP APRN BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWNE
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
MARCIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508882184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1620 BROUGHTON STREET
Provider Second Line Business Mailing Address:
P.O. BOX 2549
Provider Business Mailing Address City Name:
ORANGEBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-531-6030
Provider Business Mailing Address Fax Number:
803-531-6056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 BROUGHTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGEBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29115-4867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-531-6030
Provider Business Practice Location Address Fax Number:
803-531-6056
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  616 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F75463 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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