Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 687 | TN |
N | 213EP1101X | Primary Podiatric Medicine | 717 | AZ |
N | 213ES0131X | Foot Surgery | 0717 | AZ |
Y | 213ES0131X | Foot Surgery | 687 | TN |
NPI | 1376575969 |
---|---|
Provider Name | Patricia A Kirk |
First Address | Lexington, TN 38351-2077 |
Second Address | Lexington, TN 38351-5713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 18/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1510039 | (05) | TN |
1525058 | (05) | TN |
31970265 | (05) | NM |
4204135 | BCBS NETWORKSP,V,S, BLUECARE AND TENNCARESELECT (01) | TN |
922337 | (05) | AZ |
U77369 | (02) | |
U77369 | (02) | TN |