MEDICARE: MRS. HAYDEN STOKES KILGORE FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	902962	MS

General Provider Information

NPI Number	:	1386119295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HAYDEN STOKES KILGORE FNP-C

Provider Business Mailing Address
First Line	:	1550 CALHOUN RD
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-7881
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17540 E MAIN ST
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-2772
Country	:	US
Telephone Number	:	662-773-9509
Fax Number	:	662-779-3986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2018
Last Update Date	:	06/03/2020

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Directions to “ MRS. HAYDEN STOKES KILGORE FNP-C” Practice Location

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