Healthcare Provider Details

I. General information

NPI: 1255158903
Provider Name (Legal Business Name): ELLEN CHRISTINE KILPATRICK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN CHRISTINE HUMPHREY RN

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 TEXAS 151 ACCESS RD
SAN ANTONIO TX
78251
US

IV. Provider business mailing address

12018 ELIJAH STAPP
SAN ANTONIO TX
78253-5095
US

V. Phone/Fax

Practice location:
  • Phone: 210-771-5098
  • Fax:
Mailing address:
  • Phone: 210-240-9526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number663515
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: