Provider Demographics
NPI:1063147874
Name:KIRKPATRICK, CARLISSA (LPN)
Entity type:Individual
Prefix:
First Name:CARLISSA
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 NOME AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1878
Mailing Address - Country:US
Mailing Address - Phone:330-572-9130
Mailing Address - Fax:
Practice Address - Street 1:727 NOME AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1878
Practice Address - Country:US
Practice Address - Phone:330-572-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171359164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse