Provider Demographics
NPI:1962754184
Name:KIRK, LARRY CRAIG (PA-C)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:CRAIG
Last Name:KIRK
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 1:5141 VIRGINIA WAY
Mailing Address - Street 2:STE 390
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-9505
Mailing Address - Country:US
Mailing Address - Phone:615-933-8073
Mailing Address - Fax:615-988-1635
Practice Address - Street 1:2615 CHESTER AVENUE
Practice Address - Street 2:SAN JOAQUIN COMMUNITY HOSPITAL
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:256-548-1487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant