Provider Demographics
NPI:1699704833
Name:KILLGORE, KARAN AMANDA (MS)
Entity type:Individual
Prefix:
First Name:KARAN
Middle Name:AMANDA
Last Name:KILLGORE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:ROSEBUD
Mailing Address - State:TX
Mailing Address - Zip Code:76570-0368
Mailing Address - Country:US
Mailing Address - Phone:254-855-2039
Mailing Address - Fax:
Practice Address - Street 1:1901 S 1ST ST
Practice Address - Street 2:AUDIOLOGY SECTION
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-743-2812
Practice Address - Fax:254-743-0092
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50492231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist