Provider Demographics
NPI:1811422728
Name:KILGORE, CHARISSE MARIE
Entity Type:Individual
Prefix:MS
First Name:CHARISSE
Middle Name:MARIE
Last Name:KILGORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19770 MEREDITH AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1450
Mailing Address - Country:US
Mailing Address - Phone:216-406-5847
Mailing Address - Fax:
Practice Address - Street 1:19770 MEREDITH AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1450
Practice Address - Country:US
Practice Address - Phone:216-406-5847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide