Provider Demographics
NPI:1033319371
Name:KILGORE, TEK HOBERT JR (APRN)
Entity Type:Individual
Prefix:MR
First Name:TEK
Middle Name:HOBERT
Last Name:KILGORE
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:MR
Other - First Name:KENNETH
Other - Middle Name:HOBERT
Other - Last Name:KILGORE
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:555 FOOTHILL DRIVE
Mailing Address - Street 2:LEVEL 1
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112
Mailing Address - Country:US
Mailing Address - Phone:801-581-6431
Mailing Address - Fax:801-585-5294
Practice Address - Street 1:555 FOOTHILL DRIVE
Practice Address - Street 2:STUDEN HEALTH CENTER
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112
Practice Address - Country:US
Practice Address - Phone:801-581-6431
Practice Address - Fax:801-585-5294
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT215876-4405363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care