1619062437 NPI number — MS. KYRA KILMER NP

Table of content: MS. KYRA KILMER NP (NPI 1619062437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619062437 NPI number — MS. KYRA KILMER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILMER
Provider First Name:
KYRA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BASS/TURNER
Provider Other First Name:
KYRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619062437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED BLUFF
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96080-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-527-0350
Provider Business Mailing Address Fax Number:
530-529-3881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TEHAMA COUNTY HEALTH SERVICES CLINIC DIVISON
Provider Second Line Business Practice Location Address:
1850 WALNUT ST SUITE E
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-527-0350
Provider Business Practice Location Address Fax Number:
530-529-3881
Provider Enumeration Date:
10/04/2006

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: 363L00000X , with the licence number:  RN2259875 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN2259875 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: NP95004283 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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