Provider Demographics
NPI:1043495872
Name:KIRKPATRICK, LISA MARIE (P A C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:P A C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:VANDERPOOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1120 GREENE ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1712
Practice Address - Country:US
Practice Address - Phone:515-993-4656
Practice Address - Fax:515-993-4532
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001860363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant