Provider Demographics
NPI:1316074768
Name:KIRKHART, SENECCA ELLIOTT (CPNP)
Entity type:Individual
Prefix:
First Name:SENECCA
Middle Name:ELLIOTT
Last Name:KIRKHART
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:SENECCA
Other - Middle Name:BREMM
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:2100 WILBORN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1628
Mailing Address - Country:US
Mailing Address - Phone:434-517-8022
Mailing Address - Fax:434-517-8370
Practice Address - Street 1:2100 WILBORN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1628
Practice Address - Country:US
Practice Address - Phone:434-517-8022
Practice Address - Fax:434-517-8370
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167190363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316074768Medicaid
VA013209L19Medicare PIN
Q78138Medicare UPIN
VAC06319Medicare PIN