MEDICARE: PROF. JOAN MARIE KILLEN PH. D. RN-C FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	430606	TX

General Provider Information

NPI Number	:	1407191190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. JOAN MARIE KILLEN PH. D. RN-C FNP

Provider Business Mailing Address
First Line	:	6700 FANNIN ST
Second Line	:	TEXAS WOMAN'S UNIVERSITY COLLEGE OF NURSING
City	:	HOUSTON
State	:	TX
Zip	:	77030-2343
Country	:	US
Telephone Number	:	713-794-2100
Fax Number	:	713-794-2103

Provider Business Practice Location Address
First Line	:	6700 FANNIN ST
Second Line	:	TEXAS WOMAN'S UNIVERSITY COLLEGE OF NURSING
City	:	HOUSTON
State	:	TX
Zip	:	77030-2343
Country	:	US
Telephone Number	:	713-794-2100
Fax Number	:	713-794-2103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	12/06/2012

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