Healthcare Provider Details

I. General information

NPI: 1043814809
Provider Name (Legal Business Name): EEVIN KIRKPATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NW 165TH STREET RD STE 100
MIAMI FL
33169-6306
US

IV. Provider business mailing address

13600 NW 4TH ST APT 306
PEMBROKE PINES FL
33028-2249
US

V. Phone/Fax

Practice location:
  • Phone: 178-665-7227
  • Fax:
Mailing address:
  • Phone: 954-505-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: