Provider Demographics
NPI:1003240607
Name:KIRKLE, SUSAN LEE (ADULT PSYCH MH NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:KIRKLE
Suffix:
Gender:F
Credentials:ADULT PSYCH MH NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LEE
Other - Last Name:SANDVIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:724 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2604
Mailing Address - Country:US
Mailing Address - Phone:816-364-1501
Mailing Address - Fax:816-364-6735
Practice Address - Street 1:724 N 22ND ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2604
Practice Address - Country:US
Practice Address - Phone:816-364-1501
Practice Address - Fax:816-364-6735
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO150726363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health