Provider Demographics
NPI:1144731381
Name:KILLIAN, CHRISTOPHER CHARLES (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAY
Mailing Address - State:TX
Mailing Address - Zip Code:76366-0581
Mailing Address - Country:US
Mailing Address - Phone:940-636-2822
Mailing Address - Fax:
Practice Address - Street 1:1600 11TH ST FL 3
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4300
Practice Address - Country:US
Practice Address - Phone:940-764-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135397363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care