Provider Demographics
NPI:1093725376
Name:KIRKLAND, MARTHA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
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 1:279 DAWSON LN
Mailing Address - Street 2:
Mailing Address - City:WHITE STONE
Mailing Address - State:VA
Mailing Address - Zip Code:22578-2104
Mailing Address - Country:US
Mailing Address - Phone:804-435-2049
Mailing Address - Fax:
Practice Address - Street 1:279 DAWSON LN
Practice Address - Street 2:
Practice Address - City:WHITE STONE
Practice Address - State:VA
Practice Address - Zip Code:22578-2104
Practice Address - Country:US
Practice Address - Phone:804-435-2049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001126474367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered