Provider Demographics
NPI:1962848374
Name:AUSTIN, KIRK KAY (PA)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:KAY
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9913 WINKLE CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6277
Mailing Address - Country:US
Mailing Address - Phone:916-385-4438
Mailing Address - Fax:916-897-9900
Practice Address - Street 1:9590 OAKHAM WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5122
Practice Address - Country:US
Practice Address - Phone:916-685-3673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10387363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical