MEDICARE: BRIAN KEITH KILLEN PA-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	363AM0700X	Medical Physician Assistant	1085	TN
2	363AS0400X	Surgical Physician Assistant	1085	TN
3	363A00000X	Physician Assistant	1085	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417965526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN KEITH KILLEN PA-C

Provider Business Mailing Address
First Line	:	1 MEDICAL PARK BLVD STE 400E
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-7431
Country	:	US
Telephone Number	:	423-844-5400
Fax Number	:	423-844-5434

Provider Business Practice Location Address
First Line	:	1 MEDICAL PARK BLVD STE 400E
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-7431
Country	:	US
Telephone Number	:	423-844-5400
Fax Number	:	423-844-5434

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	03/21/2025

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