Provider Demographics
NPI:1164777389
Name:KILLMAN, NICOLE RENEE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RENEE
Last Name:KILLMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BLUE WATER DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5446
Mailing Address - Country:US
Mailing Address - Phone:626-808-3424
Mailing Address - Fax:910-640-1088
Practice Address - Street 1:304 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3602
Practice Address - Country:US
Practice Address - Phone:910-640-6615
Practice Address - Fax:910-640-1088
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCNM 502367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife