Provider Demographics
NPI:1053376855
Name:KILLEEN, JOSEPH KIMBERLY (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KIMBERLY
Last Name:KILLEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 22ND PLACE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410
Mailing Address - Country:US
Mailing Address - Phone:806-725-7800
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:4102 24 ST
Practice Address - Street 2:SUITE 502
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-725-6745
Practice Address - Fax:806-723-6716
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4931207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044739302Medicaid
E01640Medicare UPIN
TX8603M7Medicare ID - Type Unspecified