Healthcare Provider Details

I. General information

NPI: 1215903513
Provider Name (Legal Business Name): KARRIE V KILGORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 ODD FELLOWS RD
CROWLEY LA
70526-2206
US

IV. Provider business mailing address

345 ODD FELLOWS RD
CROWLEY LA
70526-2206
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-7004
  • Fax: 337-783-0070
Mailing address:
  • Phone: 337-783-7004
  • Fax: 337-783-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number022292
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: