Healthcare Provider Details

I. General information

NPI: 1548068901
Provider Name (Legal Business Name): CAROLINE MCKELLAR PILLSBURY BSN, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 JOHNSON DR
RUSK TX
75785-1804
US

IV. Provider business mailing address

113 MOCKINGBIRD LN
TYLER TX
75701-3019
US

V. Phone/Fax

Practice location:
  • Phone: 903-721-4283
  • Fax:
Mailing address:
  • Phone: 205-520-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1031995
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: