Doctor Name: | KORTNEY KYLE KILLGORE-SMITH |
NPI Number: | 1023379989 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | AP60281165 |
Business Practice Address: | 235 Main Street Waitsburg, WA - 99361 |
Business Phone Number: | 5093376311 |
Business Fax Number: | 5093376011 |
Mailing Address: | 1012 South Third Street, DAYTON |
State: | WA |
Postal Code: | 99328 |
Phone Number: | 5093822531 |
Fax Number: | 5093823205 |
NPI Enumeration Date: | 06/06/2012 |
NPI Last Update Date: | 05/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP60281165 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |