Provider Demographics
NPI:1043999279
Name:KIRKLAND, HEATHER L
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:KIRKLAND
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:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:OH
Mailing Address - Zip Code:43521-0081
Mailing Address - Country:US
Mailing Address - Phone:419-366-3691
Mailing Address - Fax:
Practice Address - Street 1:202 UNION ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:OH
Practice Address - Zip Code:43521-7759
Practice Address - Country:US
Practice Address - Phone:419-237-7085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant