Healthcare Provider Details

I. General information

NPI: 1609215789
Provider Name (Legal Business Name): PRISCILLA HOPE KILGORE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 2ND ST SUITE 430
MACON GA
31201-8298
US

IV. Provider business mailing address

164 BEAVER CREEK DR
GRAY GA
31032-5808
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-5779
  • Fax: 478-742-7796
Mailing address:
  • Phone: 478-678-5448
  • Fax: 844-280-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN131629
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: