Provider Demographics
NPI:1831466101
Name:KILLINGSWORTH, JEANNE ALLEN
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:ALLEN
Last Name:KILLINGSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JEANNE
Other - Middle Name:LAWSON
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 W HERNANDEZ ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1815
Mailing Address - Country:US
Mailing Address - Phone:850-469-3719
Mailing Address - Fax:
Practice Address - Street 1:1201 W HERNANDEZ ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1815
Practice Address - Country:US
Practice Address - Phone:850-469-3719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34095183500000X
GARPH020668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist