Provider Demographics
NPI:1548068901
Name:PILLSBURY, CAROLINE MCKELLAR (BSN, RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:MCKELLAR
Last Name:PILLSBURY
Suffix:
Gender:
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3019
Mailing Address - Country:US
Mailing Address - Phone:205-520-8497
Mailing Address - Fax:
Practice Address - Street 1:1170 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1804
Practice Address - Country:US
Practice Address - Phone:903-721-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031995163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant