Provider Demographics
NPI:1215903513
Name:KILGORE, KARRIE V (MD)
Entity type:Individual
Prefix:DR
First Name:KARRIE
Middle Name:V
Last Name:KILGORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 ODD FELLOWS RD
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-2206
Mailing Address - Country:US
Mailing Address - Phone:337-783-7004
Mailing Address - Fax:337-783-0070
Practice Address - Street 1:345 ODD FELLOWS RD
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2206
Practice Address - Country:US
Practice Address - Phone:337-783-7004
Practice Address - Fax:337-783-0070
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA080139274OtherMEDICARE RAILROAD PALMETT
LA1679411Medicaid
LA1679411Medicaid
LA5W752Medicare PIN