Provider Demographics
NPI:1023762903
Name:KILGALLON, TATUM A
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:A
Last Name:KILGALLON
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 1:523 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-1203
Mailing Address - Country:US
Mailing Address - Phone:419-371-5449
Mailing Address - Fax:
Practice Address - Street 1:4889 SINCLAIR RD STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5433
Practice Address - Country:US
Practice Address - Phone:614-885-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program