Provider Demographics
NPI:1154422962
Name:KIRK, CARYS A (PA)
Entity type:Individual
Prefix:
First Name:CARYS
Middle Name:A
Last Name:KIRK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:6 TSIENNETO RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1584
Mailing Address - Country:US
Mailing Address - Phone:603-216-0400
Mailing Address - Fax:603-216-3800
Practice Address - Street 1:16 PELHAM RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2826
Practice Address - Country:US
Practice Address - Phone:603-898-2244
Practice Address - Fax:603-898-2227
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-05-18
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Provider Licenses
StateLicense IDTaxonomies
NH0447363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAP2111Medicare ID - Type Unspecified
NHQ17547Medicare UPIN