Doctor Name: | CHANDRA KIRK |
NPI Number: | 1083996383 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 01573 |
Business Practice Address: | 306 Stanaford Rd Beckley, WV - 258013142 |
Business Phone Number: | 3042375690 |
Business Fax Number: | |
Mailing Address: | 306 Stanaford Rd, BECKLEY |
State: | WV |
Postal Code: | 258013142 |
Phone Number: | 3042375690 |
Fax Number: | |
NPI Enumeration Date: | 09/13/2011 |
NPI Last Update Date: | 05/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 01573 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |