Provider Demographics
NPI:1083026892
Name:KIRKPATRICK, JUSTIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:FNP-C
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 1587
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1587
Mailing Address - Country:US
Mailing Address - Phone:706-529-7440
Mailing Address - Fax:706-529-7437
Practice Address - Street 1:1107 MEMORIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8662
Practice Address - Country:US
Practice Address - Phone:706-226-9355
Practice Address - Fax:706-226-9380
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203897363LF0000X
GA203897363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA02548977OtherAMERIGROUP
GA1028420OtherWELLCARE
GA003152163BMedicaid
GA202I509641Medicare PIN