Provider Demographics
NPI:1568563633
Name:KIRKPATRICK, JANE D (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:D
Last Name:KIRKPATRICK
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:PO BOX 602148
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2148
Mailing Address - Country:US
Mailing Address - Phone:828-286-9036
Mailing Address - Fax:828-286-1079
Practice Address - Street 1:181 DANIEL RD
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-7151
Practice Address - Country:US
Practice Address - Phone:828-286-9036
Practice Address - Fax:828-286-1079
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500971207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110140191OtherRAILROAD MEDICARE
NC8948140Medicaid
SCN00974Medicaid
NC48140OtherBC/BS OF NC
NC1568563633Medicaid
SCN00974Medicaid
NCGO9142Medicare UPIN
NC2215446Medicare PIN