Provider Demographics
NPI:1306847173
Name:KIRLEY, STEPHEN WALTER (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WALTER
Last Name:KIRLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 LEWISVILLE-CLEMMONS RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8711
Mailing Address - Country:US
Mailing Address - Phone:336-766-7241
Mailing Address - Fax:336-766-9143
Practice Address - Street 1:2554 LEWISVILLE-CLEMMONS RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8711
Practice Address - Country:US
Practice Address - Phone:336-766-7241
Practice Address - Fax:336-766-9143
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201532084P0800X
CAC370952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8949521Medicaid
NC8949521Medicaid
2309743Medicare ID - Type Unspecified