Provider Demographics
NPI:1114991916
Name:KIRK, JOHN AARON (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:AARON
Last Name:KIRK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 GRAPHITE TRL
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3439
Mailing Address - Country:US
Mailing Address - Phone:910-813-3876
Mailing Address - Fax:
Practice Address - Street 1:5825 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-5207
Practice Address - Country:US
Practice Address - Phone:540-785-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840725363A00000X
NC0010-00517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110840725OtherLICENSSE
NC0010-00517OtherLICENSEE
NCP00419382OtherRAILROAD MEDICARE
MK 1281360OtherDEA NUMBER
NC0010-00517OtherLICENSEE
NC2767233CMedicare PIN