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General NPI Number Information
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NPI Number | 1821763442
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Entity Type | Individual
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Provider Name | SUSAN CAROL KILEY NP
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Gender | Female
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 300 E MAIN ST STE 200
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5219
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Country | US
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Telephone | 434-933-3318
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Fax | 972-646-9162
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Provider Business Mailing Address
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Address Line | 4751 CLOVER RIDGE CT
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-9214
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Country | US
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Telephone | 434-823-9835
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0024178218
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License Number State | VA
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