Provider Demographics
NPI:1558771261
Name:KIRKPATRICK FAMILY CARE
Entity Type:Organization
Organization Name:KIRKPATRICK FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-423-0390
Mailing Address - Street 1:PO BOX 1338
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-7785
Mailing Address - Country:US
Mailing Address - Phone:360-423-9580
Mailing Address - Fax:360-423-6230
Practice Address - Street 1:1706 WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2952
Practice Address - Country:US
Practice Address - Phone:360-423-9580
Practice Address - Fax:360-423-6230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60463399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty