Provider Demographics
NPI:1023596871
Name:KILCREASE, MELISSA GAIL
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAIL
Last Name:KILCREASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 BRYAN LN
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-3432
Mailing Address - Country:US
Mailing Address - Phone:251-363-0154
Mailing Address - Fax:
Practice Address - Street 1:174 HIGHWAY 113
Practice Address - Street 2:
Practice Address - City:FLOMATON
Practice Address - State:AL
Practice Address - Zip Code:36441-4556
Practice Address - Country:US
Practice Address - Phone:251-296-2456
Practice Address - Fax:251-296-2400
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-101444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily