Provider Demographics
NPI:1528204286
Name:LEDOUX, KIRK MATTHEW
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:MATTHEW
Last Name:LEDOUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:NC
Mailing Address - Zip Code:28758-0937
Mailing Address - Country:US
Mailing Address - Phone:828-697-2055
Mailing Address - Fax:
Practice Address - Street 1:305 CAUSBY LN
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-8721
Practice Address - Country:US
Practice Address - Phone:828-697-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-045-045177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging