Healthcare Provider Details

I. General information

NPI: 1346035912
Provider Name (Legal Business Name): ASHLEY KILLOREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 BARKSDALE BLVD W
BOSSIER CITY LA
71110-0000
US

IV. Provider business mailing address

70 BARKSDALE BLVD W
BOSSIER CITRY LA
71110
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-5972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: