Provider Demographics
NPI:1659639755
Name:KIRKLEY, JERRICA (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRICA
Middle Name:
Last Name:KIRKLEY
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 1:303 S BROADWAY # 200-357
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1558
Mailing Address - Country:US
Mailing Address - Phone:720-897-3749
Mailing Address - Fax:720-815-0227
Practice Address - Street 1:303 S BROADWAY # 200-357
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-1558
Practice Address - Country:US
Practice Address - Phone:720-897-3749
Practice Address - Fax:720-815-0227
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0053334207Q00000X
CO53334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44474253Medicaid