Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | TN | |
N | 2251X0800X | Physical Therapist - Orthopedic | TN |
NPI | 1124445937 |
---|---|
Provider Name | Jessica Shea Kirkland |
First Address | Kingston, TN 37763-4215 |
Second Address | Kingston, TN 37763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2014 |
Last Update Date | 19/03/2014 |