Provider Demographics
NPI:1386719219
Name:KIRKLAND, KATHY A (PA-C)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N HIGHLAND AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7389
Mailing Address - Country:US
Mailing Address - Phone:903-957-0082
Mailing Address - Fax:903-957-0351
Practice Address - Street 1:300 N HIGHLAND AVE STE 315
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7389
Practice Address - Country:US
Practice Address - Phone:903-957-0082
Practice Address - Fax:903-957-0351
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L21236Medicare PIN
TXTXB161142Medicare PIN
TNTXB161144Medicare PIN
TXTXB161143Medicare PIN