1275662256 NPI number — KENESHA HILDA KIRKLAND MD

Table of content: (NPI 1437132271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275662256 NPI number — KENESHA HILDA KIRKLAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRKLAND
Provider First Name:
KENESHA
Provider Middle Name:
HILDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275662256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 19305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28219-9305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-631-0002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9623 BAILEY RD STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORNELIUS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28031-9449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-801-8330
Provider Business Practice Location Address Fax Number:
704-801-8331
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  134152 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 134152 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 2009-01714 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5913595 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NN3294D . This is a "MEDICARE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1275662256 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NC1034 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NN3294B . This is a "MEDICARE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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