Individual
PHILIP JAKE KILLGORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 MEDICAL PLAZA PL, MINDEN, LA 71055-3330
(318) 377-2321
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
205140
LA
Other
Enumeration date
08/17/2016
Last updated
07/18/2019
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