Healthcare Provider Details

I. General information

NPI: 1093857724
Provider Name (Legal Business Name): SEAN M KILLORAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S PINE ST STE 301
TACOMA WA
98409-7264
US

IV. Provider business mailing address

6805 OLD BRIDGESITE RD
CASTLE HAYNE NC
28429-5046
US

V. Phone/Fax

Practice location:
  • Phone: 253-476-6500
  • Fax:
Mailing address:
  • Phone: 505-946-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD00011465
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: