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General NPI Number Information
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NPI Number | 1184184269
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Entity Type | Individual
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Provider Name | JENAE DYKES KILPATRICK MD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2019
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 1755 COURT ST
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City | REDDING
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State | CA
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Zip | 96001-1721
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Country | US
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Telephone | 530-247-8800
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Fax | 530-241-1174
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Provider Business Mailing Address
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Address Line | 3400 DATA DR ATTENTION: CREDENTIALING AND PAYER ENROLLMENT DEPT
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 197697
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 82701
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License Number State | SC
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