Provider Demographics
NPI:1003138256
Name:KIRKPATRICK, DAVID BERG (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BERG
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0670
Mailing Address - Country:US
Mailing Address - Phone:503-866-9742
Mailing Address - Fax:541-278-8379
Practice Address - Street 1:354 W ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-2619
Practice Address - Country:US
Practice Address - Phone:541-549-9609
Practice Address - Fax:541-278-8379
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60133720363AM0700X
ORPA186431363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical