Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 121496 | NC |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 28061 | AL |
NPI | 1023147873 |
---|---|
Provider Name | Keneshia M Kirksey |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 04/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009910528 | (05) | AL |
051542146 | BCBS OF AL (01) | AL |
051542147 | BCBS OF AL (01) | AL |
09910529 | (05) | AL |