Provider Demographics
NPI:1013314442
Name:KIRK, STEPHANIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29826 HAUN RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6546
Mailing Address - Country:US
Mailing Address - Phone:951-672-1911
Mailing Address - Fax:951-672-8406
Practice Address - Street 1:29826 HAUN RD
Practice Address - Street 2:SUITE 302
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6546
Practice Address - Country:US
Practice Address - Phone:951-672-1911
Practice Address - Fax:951-672-8406
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant