Healthcare Provider Details

I. General information

NPI: 1518214618
Provider Name (Legal Business Name): ASHLEY KATHERINE KIRKWOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 STATE ST
LA PORTE IN
46350-3115
US

IV. Provider business mailing address

1509 STATE ST
LA PORTE IN
46350-3115
US

V. Phone/Fax

Practice location:
  • Phone: 219-326-5700
  • Fax: 219-326-8131
Mailing address:
  • Phone: 219-326-5700
  • Fax: 219-326-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01074789A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: