Provider Demographics
NPI:1255158903
Name:KILPATRICK, ELLEN CHRISTINE (RN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:CHRISTINE
Last Name:KILPATRICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:CHRISTINE
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12018 ELIJAH STAPP
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5095
Mailing Address - Country:US
Mailing Address - Phone:210-240-9526
Mailing Address - Fax:
Practice Address - Street 1:9939 TEXAS 151 ACCESS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251
Practice Address - Country:US
Practice Address - Phone:210-771-5098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX663515163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator