Provider Demographics
NPI:1821763442
Name:KILEY, SUSAN CAROL (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:KILEY
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4751 CLOVER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-9214
Mailing Address - Country:US
Mailing Address - Phone:434-823-9835
Mailing Address - Fax:
Practice Address - Street 1:300 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5219
Practice Address - Country:US
Practice Address - Phone:434-933-3318
Practice Address - Fax:972-646-9162
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024178218363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology