Provider Demographics
NPI:1295751774
Name:KILCULLEN, HILARY ST JOHN (PA)
Entity type:Individual
Prefix:MS
First Name:HILARY
Middle Name:ST JOHN
Last Name:KILCULLEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-0808
Mailing Address - Country:US
Mailing Address - Phone:603-578-5054
Mailing Address - Fax:
Practice Address - Street 1:173 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-891-4400
Practice Address - Fax:603-891-4414
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0079P363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30331837Medicaid
NHKIAP1803Medicare ID - Type Unspecified
NH30331837Medicaid