Provider Demographics
NPI:1275662256
Name:KIRKLAND, KENESHA HILDA (MD)
Entity type:Individual
Prefix:
First Name:KENESHA
Middle Name:HILDA
Last Name:KIRKLAND
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:704-631-0002
Mailing Address - Fax:
Practice Address - Street 1:9623 BAILEY RD STE 220
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-9449
Practice Address - Country:US
Practice Address - Phone:704-801-8330
Practice Address - Fax:704-801-8331
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC134152207Q00000X, 207R00000X
NC2009-01714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913595Medicaid
NCNN3294DOtherMEDICARE NUMBER
NC1275662256Medicaid
SCNC1034Medicaid
NCNN3294BOtherMEDICARE NUMBER