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General NPI Number Information
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NPI Number | 1356130553
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Entity Type | Individual
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Provider Name | MARY KILCOYNE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 218 QUARTERMAN ST
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City | WAYCROSS
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State | GA
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Zip | 31501-3547
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Country | US
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Telephone | 912-287-9140
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 5TH ST SE
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City | CAIRO
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State | GA
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Zip | 39828-3142
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | GAA-NP003513
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License Number State | GA
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