Provider Demographics
NPI:1639855844
Name:KIRKUP, KIMBERLY MARIA (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIA
Last Name:KIRKUP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 PEGER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5169
Mailing Address - Country:US
Mailing Address - Phone:907-371-1300
Mailing Address - Fax:907-561-1416
Practice Address - Street 1:926 ASPEN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5501
Practice Address - Country:US
Practice Address - Phone:907-371-1300
Practice Address - Fax:907-563-2045
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY680792-1163WP0808X
AK211949363LP0808X
AK38518163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK211949OtherADVANCED PRACTICE REGISTERED NURSE
AK38518OtherREGISTERED NURSE
NY680792-01OtherREGISTERED NURSE LICENSE