Provider Demographics
NPI:1497750228
Name:KILLEBREW, KURT D (NP)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:D
Last Name:KILLEBREW
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 N LAURENT ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2743
Mailing Address - Country:US
Mailing Address - Phone:361-580-1111
Mailing Address - Fax:361-580-1122
Practice Address - Street 1:4502 N LAURENT ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2743
Practice Address - Country:US
Practice Address - Phone:361-580-1111
Practice Address - Fax:361-580-1122
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP109595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N7414OtherBLUE CROSS
TX092349201Medicaid
TX8N7414OtherBLUE CROSS
NP0354Medicare ID - Type Unspecified