Healthcare Provider Details

I. General information

NPI: 1306429154
Provider Name (Legal Business Name): MICHELLE KILLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 S HIGH ST
COLUMBUS OH
43207-1804
US

IV. Provider business mailing address

1579 S HIGH ST
COLUMBUS OH
43207-1804
US

V. Phone/Fax

Practice location:
  • Phone: 225-329-8882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberQF-2235-3561
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: