Provider Demographics
NPI:1790782845
Name:ASHBURN, KIRK D II (ARNP)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:D
Last Name:ASHBURN
Suffix:II
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 PROFESSIONAL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8002
Mailing Address - Country:US
Mailing Address - Phone:812-401-9030
Mailing Address - Fax:812-401-9033
Practice Address - Street 1:1212 PROFESSIONAL BLVD STE B
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8002
Practice Address - Country:US
Practice Address - Phone:812-401-9030
Practice Address - Fax:812-401-9033
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001760A207N00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200207810Medicaid
IN000000387509OtherANTHEM PIN
INP00333134OtherRAILROAD MEDICARE
IN200207810Medicaid
IN207610MMMMedicare ID - Type Unspecified