Basic Information
| Provider Information | |||||||||
| NPI: | 1609215789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILGORE | ||||||||
| FirstName: | PRISCILLA | ||||||||
| MiddleName: | HOPE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 164 BEAVER CREEK DR | ||||||||
| Address2: | |||||||||
| City: | GRAY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310325808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786785448 | ||||||||
| FaxNumber: | 8442807803 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 2ND ST | ||||||||
| Address2: | SUITE 430 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312018298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787455779 | ||||||||
| FaxNumber: | 4787427796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2013 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN131629 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.