Provider Demographics
NPI:1598016073
Name:KIRKPATRICK, SHELBY MAE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MAE
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1106
Mailing Address - Country:US
Mailing Address - Phone:541-274-6564
Mailing Address - Fax:541-274-6247
Practice Address - Street 1:2821 DAGGETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1106
Practice Address - Country:US
Practice Address - Phone:541-274-6733
Practice Address - Fax:541-274-6247
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA2233363LP2300X
ORPA181860363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006159Medicaid
TN103I970163Medicare PIN