Provider Demographics
NPI:1255388930
Name:QUIRK, SUSAN M (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:QUIRK
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 1:3053 MARTINS POINT RD
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3816
Mailing Address - Country:US
Mailing Address - Phone:810-278-0164
Mailing Address - Fax:
Practice Address - Street 1:5201 MAIL SERVICE CTR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27699-3440
Practice Address - Country:US
Practice Address - Phone:252-926-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000765363A00000X
KS1501132363A00000X
NC001008632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00750123OtherRR MEDICARE GROUP CU0067
KS200517950CMedicaid
KSP00750123OtherRR MEDICARE GROUP CU0067