Provider Demographics
NPI:1154321537
Name:KILGORE, JAMES R (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:KILGORE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 WOODFERN CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1467
Mailing Address - Country:US
Mailing Address - Phone:205-987-1480
Mailing Address - Fax:205-824-3677
Practice Address - Street 1:2517 WOODFERN CIR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1467
Practice Address - Country:US
Practice Address - Phone:205-987-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL149363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant