Provider Demographics
NPI:1245714088
Name:KILDRON, KAREN PATIENCE (MS, SSP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:PATIENCE
Last Name:KILDRON
Suffix:
Gender:F
Credentials:MS, SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 CHOCTAW TRL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3815
Mailing Address - Country:US
Mailing Address - Phone:803-840-6052
Mailing Address - Fax:
Practice Address - Street 1:1669 CHOCTAW TRL
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-3815
Practice Address - Country:US
Practice Address - Phone:803-840-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH17546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty