Provider Demographics
NPI:1528158383
Name:KIRKOWSKI, PATRICIA M (APRN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:KIRKOWSKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1406
Mailing Address - Country:US
Mailing Address - Phone:570-297-4416
Mailing Address - Fax:
Practice Address - Street 1:21 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1803
Practice Address - Country:US
Practice Address - Phone:570-265-2525
Practice Address - Fax:570-265-1075
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN196173L163WP0809X, 364S00000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
S12764Medicare UPIN
KI440586Medicare ID - Type Unspecified