Provider Demographics
NPI:1891209037
Name:FILMORE, KHALILAH N (LPN, CFT)
Entity Type:Individual
Prefix:
First Name:KHALILAH
Middle Name:N
Last Name:FILMORE
Suffix:
Gender:F
Credentials:LPN, CFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 EMERALD TREE LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9184
Mailing Address - Country:US
Mailing Address - Phone:407-203-9911
Mailing Address - Fax:
Practice Address - Street 1:3902 EMERALD TREE LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-9184
Practice Address - Country:US
Practice Address - Phone:407-203-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5147598164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse