Provider Demographics
NPI:1205043957
Name:KILLOUGH, LINDA KAY (RN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:KILLOUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 WHITEHALL DR APT 106
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1060
Mailing Address - Country:US
Mailing Address - Phone:561-776-7112
Mailing Address - Fax:561-776-7113
Practice Address - Street 1:4060 PGA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6574
Practice Address - Country:US
Practice Address - Phone:561-776-7112
Practice Address - Fax:561-776-7113
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL858692163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant