Provider Demographics
NPI:1235024225
Name:KIRTLEY, CHRISTOPHER BRET
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:BRET
Last Name:KIRTLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 WILLOWBANK RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-3310
Mailing Address - Country:US
Mailing Address - Phone:843-240-6048
Mailing Address - Fax:
Practice Address - Street 1:804 WILLOWBANK RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3310
Practice Address - Country:US
Practice Address - Phone:843-240-6048
Practice Address - Fax:843-240-6048
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant