Provider Demographics
NPI:1982201760
Name:VAN KIRK, JAIME LYN
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYN
Last Name:VAN KIRK
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 1:233 PADGETTS ORDINARY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5578
Mailing Address - Country:US
Mailing Address - Phone:757-345-9212
Mailing Address - Fax:
Practice Address - Street 1:233 PADGETTS ORDINARY
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5578
Practice Address - Country:US
Practice Address - Phone:757-345-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program