Healthcare Provider Details

I. General information

NPI: 1609606706
Provider Name (Legal Business Name): JARRETT KILGORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4062 HIXSON PIKE
CHATTANOOGA TN
37415-3110
US

IV. Provider business mailing address

4062 HIXSON PIKE
CHATTANOOGA TN
37415-3110
US

V. Phone/Fax

Practice location:
  • Phone: 423-877-3568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48010
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: