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NPI Code Detail

MEDICARE: ANGELA MICHELLE OWEN-KILLAR MA

MEDICARE: ANGELA MICHELLE OWEN-KILLAR MA
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
1103TC0700XClinical Psychologist2091NC
2103T00000XPsychologist2091NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1046JXOTHERNCBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1629149026
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA MICHELLE OWEN-KILLAR MA
Provider Business Mailing Address
First Line : 236 LE PHILLIP CT NE STE D
Second Line :
City : CONCORD
State : NC
Zip : 28025-1917
Country : US
Telephone Number : 704-652-1188
Fax Number :
Provider Business Practice Location Address
First Line : 236 LE PHILLIP CT
Second Line : SUITE D
City : CONCORD
State : NC
Zip : 28025-1905
Country : US
Telephone Number : 704-786-4503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2006
Last Update Date : 10/05/2021

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Directions to “ ANGELA MICHELLE OWEN-KILLAR MA” Practice Location

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