Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 150726 | MO |
NPI | 1003240607 |
---|---|
Provider Name | Susan Lee Kirkle |
First Address | Saint Joseph, MO 64506-2604 |
Second Address | Saint Joseph, MO 64506-2604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2013 |
Last Update Date | 30/08/2013 |