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General NPI Number Information
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NPI Number | 1477903284
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Entity Type | Individual
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Provider Name | TRACY KILLIAN NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 2893 VETERANS MEMORIAL PKWY
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City | SAINT CHARLES
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State | MO
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Zip | 63303-3526
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Country | US
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Telephone | 636-336-1401
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Fax |
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Provider Business Mailing Address
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Address Line | 2666 BABBLE CREEK LN
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City | O FALLON
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State | MO
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Zip | 63368-8334
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Country | US
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Telephone | 636-379-0209
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 145843
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License Number State | MO
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