Provider Demographics
NPI:1487246062
Name:KILGORE, CAROLYN L (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:L
Last Name:KILGORE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4099 GRASMERE RUN
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7278
Mailing Address - Country:US
Mailing Address - Phone:513-601-7652
Mailing Address - Fax:
Practice Address - Street 1:1104 RAYFORD RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-5091
Practice Address - Country:US
Practice Address - Phone:281-825-3265
Practice Address - Fax:281-825-3264
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069126363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner