1639908601 NPI number — MRS. LUCINDA LOU KIL GILLIS N.P.

Table of content: MRS. LUCINDA LOU KIL GILLIS N.P. (NPI 1639908601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639908601 NPI number — MRS. LUCINDA LOU KIL GILLIS N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLIS
Provider First Name:
LUCINDA
Provider Middle Name:
LOU KIL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIL
Provider Other First Name:
LUCINDA
Provider Other Middle Name:
LOU
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N., J.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639908601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3245 HEALTH DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANGER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46530-1380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17434 STATE ROAD 23
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46635-1743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-329-0241
Provider Business Practice Location Address Fax Number:
574-272-6429
Provider Enumeration Date:
07/29/2024

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: 363LP0808X , with the licence number:  71015554A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300098665 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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