Provider Demographics
NPI:1326403536
Name:KIRKWOOD, JESSICA MICHELLE (MSN, RN, WHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHELLE
Last Name:KIRKWOOD
Suffix:
Gender:F
Credentials:MSN, RN, WHNP-BC
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Mailing Address - Street 1:11318 BRIDGEPORT WAY SW STE A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3054
Mailing Address - Country:US
Mailing Address - Phone:253-380-8905
Mailing Address - Fax:253-353-7334
Practice Address - Street 1:11318 BRIDGEPORT WAY SW STE A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3054
Practice Address - Country:US
Practice Address - Phone:253-380-8905
Practice Address - Fax:253-353-7334
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60590540363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2135058Medicaid