MEDICARE: MRS. NEKISHA KILLINGS MPH, IBCLC

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	174N00000X	Lactation Consultant (Non-RN)	L-82473	FL

General Provider Information

NPI Number	:	1861857583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NEKISHA KILLINGS MPH, IBCLC

Provider Business Mailing Address
First Line	:	3425 BAYSIDE LAKES BLVD SE # 103-1032
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6867
Country	:	US
Telephone Number	:	805-793-0499
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 BAYSIDE LAKES BLVD SE # 103-1032
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6867
Country	:	US
Telephone Number	:	805-793-0499
Fax Number	:

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

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	02/06/2021

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