Provider Demographics
NPI:1811933120
Name:KIRKLAND, SANDRA L (DNS FNP, BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:DNS FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2544
Mailing Address - Country:US
Mailing Address - Phone:901-853-9700
Mailing Address - Fax:901-853-9996
Practice Address - Street 1:790 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2544
Practice Address - Country:US
Practice Address - Phone:901-853-9700
Practice Address - Fax:901-853-9996
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3641899Medicare ID - Type Unspecified