Provider Demographics
NPI:1194357202
Name:KIRKLAND, LAWANDA L
Entity Type:Individual
Prefix:
First Name:LAWANDA
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 1:298 COMMERCE PARK DR STE D
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2237
Mailing Address - Country:US
Mailing Address - Phone:601-790-1260
Mailing Address - Fax:601-605-7060
Practice Address - Street 1:298 COMMERCE PARK DR STE D
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2237
Practice Address - Country:US
Practice Address - Phone:601-790-1260
Practice Address - Fax:601-605-7060
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS865575163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty