Provider Demographics
NPI:1730775958
Name:KILGORE, MATIA (APRN, DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:MATIA
Middle Name:
Last Name:KILGORE
Suffix:
Gender:F
Credentials:APRN, DNP, FNP-C
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 471112
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20753-1112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1907 BORDER AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3606
Practice Address - Country:US
Practice Address - Phone:844-443-6246
Practice Address - Fax:833-907-2235
Is Sole Proprietor?:No
Enumeration Date:2020-12-13
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily