Provider Demographics
NPI:1972960078
Name:KIRKSEY, SANDRA LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:KIRKSEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:GORDON BITAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2975 REDHILL AVENUE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-415-4639
Mailing Address - Fax:
Practice Address - Street 1:104 CLAYTON CROSSING
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:TEXAS
Practice Address - Zip Code:76082
Practice Address - Country:UM
Practice Address - Phone:512-277-0951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003079363LF0000X
TXT225344363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily