Provider Demographics
NPI:1043948482
Name:ADULT AND GERIATRIC HEALTHCARE PLLC
Entity Type:Organization
Organization Name:ADULT AND GERIATRIC HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:SHUANDALE
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:828-228-5326
Mailing Address - Street 1:325 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-2940
Mailing Address - Country:US
Mailing Address - Phone:828-228-5326
Mailing Address - Fax:
Practice Address - Street 1:325 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-2940
Practice Address - Country:US
Practice Address - Phone:828-228-5326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1114493111Medicaid