Provider Demographics
NPI:1376575969
Name:KIRK, PATRICIA A (DPM)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:KIRK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 W CHURCH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-2077
Mailing Address - Country:US
Mailing Address - Phone:731-249-5230
Mailing Address - Fax:731-506-4888
Practice Address - Street 1:9486 HIGHWAY 412 W
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-5713
Practice Address - Country:US
Practice Address - Phone:731-249-5230
Practice Address - Fax:731-506-4888
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ717213EP1101X
TN687213EP1101X, 213ES0131X
AZ0717213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525058Medicaid
TN4204135OtherBCBS NETWORKSP,V,S, BLUECARE AND TENNCARESELECT
AZ922337Medicaid
NM31970265Medicaid
TN1510039Medicaid
U77369Medicare UPIN
TX8HD452Medicare ID - Type UnspecifiedHSZ001
AZ922337Medicaid
TN3350016Medicare PIN
TX8HD451Medicare ID - Type UnspecifiedHSZ006
TN103I41864Medicare PIN