Provider Demographics
NPI:1003284555
Name:KILBOY, MATTHEW JAMES (RN, ATC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:KILBOY
Suffix:
Gender:M
Credentials:RN, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 MAHONING RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44411-9737
Mailing Address - Country:US
Mailing Address - Phone:234-255-5252
Mailing Address - Fax:
Practice Address - Street 1:2271 MAHONING RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:OH
Practice Address - Zip Code:44411-9737
Practice Address - Country:US
Practice Address - Phone:234-255-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC163W00000X163W00000X
DCRN1053313163WM0705X
2255A2300X
OHRN.367423163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer