Provider Demographics
NPI:1144537226
Name:KILGORE-WILSON, GENA R (MBA)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:R
Last Name:KILGORE-WILSON
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5095 ELVIS PRESLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-8211
Mailing Address - Country:US
Mailing Address - Phone:901-396-4659
Mailing Address - Fax:901-346-8113
Practice Address - Street 1:5095 ELVIS PRESLEY BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-8211
Practice Address - Country:US
Practice Address - Phone:901-396-4659
Practice Address - Fax:901-346-8113
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor