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General NPI Number Information
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NPI Number | 1356961544
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Entity Type | Individual
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Provider Name | GREGORY KILPATRICK II
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Gender | Male
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Dates
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Enumeration Date | 04/17/2020
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | 910 HOPE MILLS RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4243
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Country | US
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Telephone | 910-600-8209
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 25022
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5000
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Country | US
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Telephone | 910-600-8209
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 218721
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 485921
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License Number State | NC
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