Provider Demographics
NPI:1932291010
Name:EDWARDS KILDOW, BRITTAINY RAELENA (PT)
Entity Type:Individual
Prefix:
First Name:BRITTAINY
Middle Name:RAELENA
Last Name:EDWARDS KILDOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4416
Mailing Address - Country:US
Mailing Address - Phone:910-385-7149
Mailing Address - Fax:910-251-8607
Practice Address - Street 1:159 CROSSOVER RD
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-8801
Practice Address - Country:US
Practice Address - Phone:910-298-6455
Practice Address - Fax:910-298-6405
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9424208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211906Medicaid
NC7211906Medicaid