Healthcare Provider Details

I. General information

NPI: 1730775958
Provider Name (Legal Business Name): MATIA KILGORE APRN, DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2020
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 BORDER AVE
TORRANCE CA
90501-3606
US

IV. Provider business mailing address

2 UNIVERSITY PLZ
HACKENSACK NJ
07601-6202
US

V. Phone/Fax

Practice location:
  • Phone: 844-443-6246
  • Fax: 833-907-2235
Mailing address:
  • Phone: 551-295-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR191993
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: