Provider Demographics
NPI:1376583476
Name:KIRKHART, LAUREL A (MD)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:A
Last Name:KIRKHART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5381
Mailing Address - Fax:740-446-5082
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5381
Practice Address - Fax:740-446-5082
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16692207V00000X
OH35.059691207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
001714055OtherMOUNTAIN STATE BCBS
OH310917085077OtherCARESOURCE MEDICAID
OH000000181655OtherUNISON MEDICAID
000000007636OtherANTHEM BCBS
OH0798418OtherMOLINA MEDICAID
160017397OtherRR MEDICARE
WV0091828000Medicaid
OH0798418Medicaid
OH310917085077OtherCARESOURCE MEDICAID
OH0798418OtherMOLINA MEDICAID
160017397OtherRR MEDICARE