Provider Demographics
NPI:1750383360
Name:KILPATRICK, BYRON (MD)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:KILPATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:595 W LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7071
Practice Address - Country:US
Practice Address - Phone:702-566-5500
Practice Address - Fax:702-558-7237
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV4292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4292OtherSTATE LICENSE
NV1750383360Medicaid