Provider Demographics
NPI:1134211097
Name:KILCAWLEY, VICTORIA SMITH (FNP-BC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SMITH
Last Name:KILCAWLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277723
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7723
Mailing Address - Country:US
Mailing Address - Phone:864-560-4123
Mailing Address - Fax:864-560-4023
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:CARDIO PULM LAB
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-8154
Practice Address - Fax:864-560-6716
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF1159363LF0000X
SC1159363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0572Medicaid
SCQ328393365Medicare PIN
SCNP0572Medicaid
SCQ32839Medicare ID - Type Unspecified