Healthcare Provider Details

I. General information

NPI: 1457727323
Provider Name (Legal Business Name): SUE KILGORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W THUNDERBIRD RD SUITE F1
GLENDALE AZ
85306-4636
US

IV. Provider business mailing address

2620 ELM HILL PIKE SUITE F1
NASHVILLE TN
37214-3108
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-6960
  • Fax:
Mailing address:
  • Phone: 615-425-4200
  • Fax: 615-425-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTAP8030
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: