Provider Demographics
NPI:1033633359
Name:KIRKLIN, LISHA
Entity Type:Individual
Prefix:
First Name:LISHA
Middle Name:
Last Name:KIRKLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-3120
Mailing Address - Country:US
Mailing Address - Phone:225-313-2284
Mailing Address - Fax:
Practice Address - Street 1:225 S. ELM ST.
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052
Practice Address - Country:US
Practice Address - Phone:225-313-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator