Provider Demographics
NPI:1730064684
Name:KILLIAN, GABRIEL ELIJAH (RN, BSN)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ELIJAH
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 HOLT RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65550-8700
Mailing Address - Country:US
Mailing Address - Phone:573-612-4034
Mailing Address - Fax:
Practice Address - Street 1:1000 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2905
Practice Address - Country:US
Practice Address - Phone:573-458-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024024076163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse