Provider Demographics
NPI:1326074410
Name:KILLGORE, JOHN E (NP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:KILLGORE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 SMITH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4914
Mailing Address - Country:US
Mailing Address - Phone:252-535-8715
Mailing Address - Fax:
Practice Address - Street 1:1403 S KING ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-9666
Practice Address - Country:US
Practice Address - Phone:252-794-6600
Practice Address - Fax:252-794-6605
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
2802671DMedicare PIN
S78992Medicare UPIN