Provider Demographics
NPI:1275720492
Name:KIRKLAND, PHILLIP DARRELL (PA)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DARRELL
Last Name:KIRKLAND
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 BEAVER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-3314
Mailing Address - Country:US
Mailing Address - Phone:865-414-6654
Mailing Address - Fax:
Practice Address - Street 1:8115 BEAVER RIDGE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-3314
Practice Address - Country:US
Practice Address - Phone:865-414-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1277363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4177381OtherBLUECROSS BLUESHIELD
TN1516699Medicaid
TN1516699Medicaid
TN103I972924Medicare PIN