Provider Demographics
NPI:1881636306
Name:KILLINGS, KAYE (CFNP)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:
Last Name:KILLINGS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 GALAXIE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4308
Mailing Address - Country:US
Mailing Address - Phone:601-713-0890
Mailing Address - Fax:601-366-3415
Practice Address - Street 1:5160 GALAXIE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4308
Practice Address - Country:US
Practice Address - Phone:601-713-0890
Practice Address - Fax:601-366-3415
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR501565363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00111588Medicaid
MS00111588Medicaid
MS500000860Medicare ID - Type UnspecifiedMEDICARE