Provider Demographics
NPI:1659348027
Name:KILLINGSWORTH, SANDRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:S
Last Name:KILLINGSWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 RESEARCH PARK DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5000
Mailing Address - Country:US
Mailing Address - Phone:785-537-2651
Mailing Address - Fax:
Practice Address - Street 1:1325 RESEARCH PARK DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5000
Practice Address - Country:US
Practice Address - Phone:785-537-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100418060DMedicaid
KS068002174OtherMEDICARE PTAN
KS100418060AMedicaid
KS100418060DMedicaid
KS100418060AMedicaid