Provider Demographics
NPI:1306525464
Name:KILLEEN, CORY (APRN, FNP)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:KILLEEN
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 WASHINGTON ST UNIT 145
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2997
Mailing Address - Country:US
Mailing Address - Phone:360-694-3060
Mailing Address - Fax:
Practice Address - Street 1:1207 WASHINGTON ST UNIT 145
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2997
Practice Address - Country:US
Practice Address - Phone:360-694-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61457036363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner