Healthcare Provider Details

I. General information

NPI: 1346816329
Provider Name (Legal Business Name): DAPHNE KWON KILBOURNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 SHUCKIN ST UNIT 105
HAMPSTEAD NC
28443-8731
US

IV. Provider business mailing address

4655 AZALEA LANDING DR APT 205
WILMINGTON NC
28405-0307
US

V. Phone/Fax

Practice location:
  • Phone: 910-599-2230
  • Fax:
Mailing address:
  • Phone: 517-657-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: