Provider Demographics
NPI:1932210481
Name:KILGORE, KATHERINE (PHD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KILGORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13405 FOLSOM BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4738
Mailing Address - Country:US
Mailing Address - Phone:916-458-5505
Mailing Address - Fax:916-357-5964
Practice Address - Street 1:13405 FOLSOM BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4738
Practice Address - Country:US
Practice Address - Phone:916-458-5505
Practice Address - Fax:916-357-5964
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14094103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA434250OtherPTAN
CA1770765794OtherMEDICARE CORPORATION NPI
CA1770765794OtherMEDICARE CORPORATION NPI
CA1770765794OtherMEDICARE CORPORATION NPI
CA1770765794OtherMEDICARE CORPORATION NPI