Provider Demographics
NPI:1164058186
Name:KIRKMAN, RENITA
Entity Type:Individual
Prefix:
First Name:RENITA
Middle Name:
Last Name:KIRKMAN
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 1:11560 NC 55 HWY STE 7
Mailing Address - Street 2:
Mailing Address - City:GRANTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28529-9447
Mailing Address - Country:US
Mailing Address - Phone:252-242-0088
Mailing Address - Fax:
Practice Address - Street 1:11560 NC 55 HWY STE 7
Practice Address - Street 2:
Practice Address - City:GRANTSBORO
Practice Address - State:NC
Practice Address - Zip Code:28529-9447
Practice Address - Country:US
Practice Address - Phone:252-242-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5411253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care