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General NPI Number Information
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NPI Number | 1043948482
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Entity Type | Organization
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Legal Business Name | ADULT AND GERIATRIC HEALTHCARE PLLC
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 325 1ST AVE SW
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City | HICKORY
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State | NC
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Zip | 28602-2940
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Country | US
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Telephone | 828-228-5326
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Fax |
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Provider Business Mailing Address
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Address Line | 325 1ST AVE SW
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City | HICKORY
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State | NC
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Zip | 28602-2940
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Country | US
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Telephone | 828-228-5326
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTAL SHUANDALE KILLIAN
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Credential | NP
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Telephone | 828-228-5326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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