Provider Demographics
NPI:1043095458
Name:KIRKER, BEVERLY JANE (RDHBSN,AS)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JANE
Last Name:KIRKER
Suffix:
Gender:F
Credentials:RDHBSN,AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 FRANK MCMILLION RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-9465
Mailing Address - Country:US
Mailing Address - Phone:304-619-9312
Mailing Address - Fax:
Practice Address - Street 1:51 FRANK MCMILLION RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9465
Practice Address - Country:US
Practice Address - Phone:304-619-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2361124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist