Provider Demographics
NPI:1891038071
Name:KILLINGSWORTH, ANTOINIECE
Entity Type:Individual
Prefix:
First Name:ANTOINIECE
Middle Name:
Last Name:KILLINGSWORTH
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 1:6223 E SAHARA AVE
Mailing Address - Street 2:#41
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-2806
Mailing Address - Country:US
Mailing Address - Phone:714-757-2005
Mailing Address - Fax:
Practice Address - Street 1:6223 E SAHARA AVE
Practice Address - Street 2:#41
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-2806
Practice Address - Country:US
Practice Address - Phone:714-757-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner