Provider Demographics
NPI:1942779285
Name:KIRKLAND, STACI KAISER (NP)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:KAISER
Last Name:KIRKLAND
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 1:3134 PACES STATION RDG
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4074
Mailing Address - Country:US
Mailing Address - Phone:251-213-0703
Mailing Address - Fax:
Practice Address - Street 1:960 JOHNSON FERRY RD STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1630
Practice Address - Country:US
Practice Address - Phone:404-257-0006
Practice Address - Fax:404-851-1316
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN226580363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care