Healthcare Provider Details

I. General information

NPI: 1033427406
Provider Name (Legal Business Name): CONNIE RHOADES KILLAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CONNIE LOUISE RHOADES

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 N FERDON BLVD
CRESTVIEW FL
32536-2753
US

IV. Provider business mailing address

596 N FERDON BLVD
CRESTVIEW FL
32536-2753
US

V. Phone/Fax

Practice location:
  • Phone: 850-306-3268
  • Fax: 850-398-5029
Mailing address:
  • Phone: 850-306-3268
  • Fax: 850-398-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN2623762
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAPRN2623762
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 1-085282
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: