Provider Demographics
NPI:1922395573
Name:KILGORE, ANITA SUE
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:SUE
Last Name:KILGORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:ANITA
Other - Middle Name:SUE
Other - Last Name:KILGORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27753 S WELLING RD
Mailing Address - Street 2:
Mailing Address - City:WELLING
Mailing Address - State:OK
Mailing Address - Zip Code:74471-2202
Mailing Address - Country:US
Mailing Address - Phone:918-457-4999
Mailing Address - Fax:
Practice Address - Street 1:27753 S WELLING RD
Practice Address - Street 2:
Practice Address - City:WELLING
Practice Address - State:OK
Practice Address - Zip Code:74471-2202
Practice Address - Country:US
Practice Address - Phone:918-457-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator