1245690551 NPI number — DR. DUSTIN RICHARD KILPATRICK DO

Table of content: DR. DUSTIN RICHARD KILPATRICK DO (NPI 1245690551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245690551 NPI number — DR. DUSTIN RICHARD KILPATRICK DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILPATRICK
Provider First Name:
DUSTIN
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245690551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1208 HICKORY BLVD SW STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENOIR
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28645-6461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-580-7048
Provider Business Mailing Address Fax Number:
828-580-3985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1208 HICKORY BLVD SW STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28645-6461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-580-7048
Provider Business Practice Location Address Fax Number:
828-580-3985
Provider Enumeration Date:
02/29/2016

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: 207RG0100X , with the licence number:  2019-01207 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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