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General NPI Number Information
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NPI Number | 1659081818
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Entity Type | Individual
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Provider Name | AUDREY W KILGORE BS, TCM, MMHC, CCC
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Gender | Female
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 06/03/2023
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Provider Practice Location Address
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Address Line | 2140 KINGSLEY AVE STE 2
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City | ORANGE PARK
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State | FL
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Zip | 32073-5129
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Country | US
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Telephone | 904-579-3515
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Fax |
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Provider Business Mailing Address
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Address Line | 900 TREE STAND CT
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City | JACKSONVILLE
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State | FL
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Zip | 32234-3068
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Country | US
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Telephone | 904-626-0115
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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