Provider Demographics
NPI:1356533731
Name:KIRKLAND, TERESA A (IDC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CODE 100 M, BUILDING 277
Mailing Address - Street 2:NORFOLK NAVAL SHIPYARD
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23709-5000
Mailing Address - Country:US
Mailing Address - Phone:757-953-6454
Mailing Address - Fax:
Practice Address - Street 1:CODE 100 M, BUILDING 277
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23709-5000
Practice Address - Country:US
Practice Address - Phone:757-953-6454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman