Provider Demographics
NPI:1922455666
Name:KIRKSEY, AIDIA
Entity Type:Individual
Prefix:
First Name:AIDIA
Middle Name:
Last Name:KIRKSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SAND PINE TRL
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1253
Mailing Address - Country:US
Mailing Address - Phone:850-556-0904
Mailing Address - Fax:850-888-3058
Practice Address - Street 1:114 SAND PINE TRL
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327
Practice Address - Country:US
Practice Address - Phone:850-556-0904
Practice Address - Fax:850-888-3058
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No171W00000XOther Service ProvidersContractor