Healthcare Provider Details

I. General information

NPI: 1588903777
Provider Name (Legal Business Name): DARRIN JOHN KIRKENDALL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 UNIVERSITY BLVD S STE 203
JACKSONVILLE FL
32216-4389
US

IV. Provider business mailing address

1201 MACLAREN ST
ST AUGUSTINE FL
32092-3431
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-0085
  • Fax:
Mailing address:
  • Phone: 904-679-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: