Provider Demographics
NPI:1154048999
Name:DAUGHTRY, KILEY DONITA (N/A)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:DONITA
Last Name:DAUGHTRY
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:KILEY
Other - Middle Name:DONITA
Other - Last Name:DAUGHTRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:703 JIM BLAKE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-7705
Mailing Address - Country:US
Mailing Address - Phone:910-967-0374
Mailing Address - Fax:910-469-1275
Practice Address - Street 1:703 JIM BLAKE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-7705
Practice Address - Country:US
Practice Address - Phone:910-967-0374
Practice Address - Fax:910-469-1275
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility