Provider Demographics
NPI:1407587835
Name:MITCHELL, KIRKLIN TUCKER (PA-C)
Entity type:Individual
Prefix:
First Name:KIRKLIN
Middle Name:TUCKER
Last Name:MITCHELL
Suffix:
Gender:M
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 1:700 FOULK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3708
Mailing Address - Country:US
Mailing Address - Phone:302-764-0181
Mailing Address - Fax:
Practice Address - Street 1:700 FOULK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3708
Practice Address - Country:US
Practice Address - Phone:302-764-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA006145363A00000X
DEC5-0011925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant