Provider Demographics
NPI:1649433806
Name:KILLGORE, NANCY GUMBERTS (ANP BC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:GUMBERTS
Last Name:KILLGORE
Suffix:
Gender:F
Credentials:ANP BC
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Mailing Address - Street 1:9430 PARKWEST BOULEVARD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4204
Mailing Address - Country:US
Mailing Address - Phone:865-694-9886
Mailing Address - Fax:865-694-5023
Practice Address - Street 1:9430 PARKWEST BOULEVARD
Practice Address - Street 2:SUITE 240
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4204
Practice Address - Country:US
Practice Address - Phone:865-694-9886
Practice Address - Fax:865-694-5023
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013477363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health