Provider Demographics
NPI:1033427406
Name:KILLAM, CONNIE RHOADES (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:RHOADES
Last Name:KILLAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:CONNIE
Other - Middle Name:LOUISE
Other - Last Name:RHOADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:596 N FERDON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2753
Mailing Address - Country:US
Mailing Address - Phone:850-306-3268
Mailing Address - Fax:850-398-5029
Practice Address - Street 1:596 N FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2753
Practice Address - Country:US
Practice Address - Phone:850-306-3268
Practice Address - Fax:850-398-5029
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2623762363LW0102X, 363LN0005X
ALRN 1-085282163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care