Provider Demographics
NPI:1205945227
Name:KILGORE, NANCY HAYES (DMIN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:HAYES
Last Name:KILGORE
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 LYME RD
Mailing Address - Street 2:SUITE 210A
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 LYME RD
Practice Address - Street 2:SUITE 210A
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1219
Practice Address - Country:US
Practice Address - Phone:603-643-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH59101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011150Medicaid