Healthcare Provider Details

I. General information

NPI: 1790102374
Provider Name (Legal Business Name): JESSICA KILGORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 TUDOR LN
CLEARWATER FL
33763-1449
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 727-222-0532
  • Fax:
Mailing address:
  • Phone: 727-222-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: