Provider Demographics
NPI:1598951550
Name:KIRKMAN, CHRISTINE LOUISE (MSN,RN,PNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:KIRKMAN
Suffix:
Gender:F
Credentials:MSN,RN,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4500 PEWTER LANE
Mailing Address - Street 2:BUILDING 8 & 9
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104
Mailing Address - Country:US
Mailing Address - Phone:315-692-2037
Mailing Address - Fax:315-692-2102
Practice Address - Street 1:4500 PEWTER LANE
Practice Address - Street 2:BUILDING 8 & 9
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104
Practice Address - Country:US
Practice Address - Phone:315-692-2037
Practice Address - Fax:315-692-2102
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY342922163W00000X
NYF382460-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03972034Medicaid
NYJ400191189Medicare PIN