Provider Demographics
NPI:1184932501
Name:KIRKMAN, RONNIE A (C,PED)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:A
Last Name:KIRKMAN
Suffix:
Gender:M
Credentials:C,PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 ROCKFORD ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-6587
Mailing Address - Country:US
Mailing Address - Phone:336-789-8494
Mailing Address - Fax:336-789-8561
Practice Address - Street 1:2133 ROCKFORD ST
Practice Address - Street 2:SUITE 500
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-6587
Practice Address - Country:US
Practice Address - Phone:336-789-8494
Practice Address - Fax:336-789-8561
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335E00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795476Medicaid