Provider Demographics
NPI:1689922494
Name:KILBURN, KATRINA (NP, LISW)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:KILBURN
Suffix:
Gender:F
Credentials:NP, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38104 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-3838
Mailing Address - Country:US
Mailing Address - Phone:614-370-5512
Mailing Address - Fax:
Practice Address - Street 1:1425 S US 301
Practice Address - Street 2:
Practice Address - City:SUMTERVILLE
Practice Address - State:FL
Practice Address - Zip Code:33585-5141
Practice Address - Country:US
Practice Address - Phone:352-793-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI12012781041C0700X
FL11040244363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical