Provider Demographics
NPI:1649370834
Name:KIRKLAND, CAROL ANN (FNP C)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:EVELEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP C
Mailing Address - Street 1:318 ABALONE LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340
Mailing Address - Country:US
Mailing Address - Phone:575-464-4441
Mailing Address - Fax:575-464-4422
Practice Address - Street 1:318 ABALONE LOOP ROAD
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340-0210
Practice Address - Country:US
Practice Address - Phone:575-464-4441
Practice Address - Fax:575-464-4422
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID686A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily