Provider Demographics
NPI:1427889211
Name:KIRKLAND, GRACE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
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 1:130 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3240
Mailing Address - Country:US
Mailing Address - Phone:615-346-9437
Mailing Address - Fax:
Practice Address - Street 1:130 N SPRING ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3240
Practice Address - Country:US
Practice Address - Phone:615-346-9437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6104363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant