Provider Demographics
NPI:1295425544
Name:KIRKER, AMY (LPN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KIRKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 BOLAND RD
Mailing Address - Street 2:
Mailing Address - City:RICHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13681-3129
Mailing Address - Country:US
Mailing Address - Phone:315-323-8902
Mailing Address - Fax:
Practice Address - Street 1:1003 PARK ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-3911
Practice Address - Country:US
Practice Address - Phone:315-713-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315340164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse