Healthcare Provider Details

I. General information

NPI: 1447694104
Provider Name (Legal Business Name): ERIN K KIRKPATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 OLD JACKSONVILLE RD STE 110
SPRINGFIELD IL
62704-7401
US

IV. Provider business mailing address

3132 OLD JACKSONVILLE RD STE 110
SPRINGFIELD IL
62704-7401
US

V. Phone/Fax

Practice location:
  • Phone: 217-588-2600
  • Fax:
Mailing address:
  • Phone: 217-588-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085004614
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: