Provider Demographics
NPI:1568912855
Name:KILGORE, DEBRA FAY (RN, MN, CNM)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:FAY
Last Name:KILGORE
Suffix:
Gender:F
Credentials:RN, MN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-567-9355
Mailing Address - Fax:
Practice Address - Street 1:7703 FLOYD CURL DR RM 1.422
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-9355
Practice Address - Fax:210-567-5903
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132018367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387616101Medicaid