Provider Demographics
NPI:1134333016
Name:KILGORE, VIRGINIA L (KCSA)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:L
Last Name:KILGORE
Suffix:
Gender:F
Credentials:KCSA
Other - Prefix:MS
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:KILGORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:507 INDIAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2217
Mailing Address - Country:US
Mailing Address - Phone:502-721-8334
Mailing Address - Fax:502-721-8334
Practice Address - Street 1:507 INDIAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2217
Practice Address - Country:US
Practice Address - Phone:502-721-8334
Practice Address - Fax:502-721-8334
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist