Healthcare Provider Details

I. General information

NPI: 1790143642
Provider Name (Legal Business Name): CHRISTINA KIRKPATRICK PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2016
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 THOMAS JOHNSON DR STE 101
FREDERICK MD
21702-4427
US

IV. Provider business mailing address

87 THOMAS JOHNSON DR STE 101
FREDERICK MD
21702-4427
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-0606
  • Fax: 301-662-6928
Mailing address:
  • Phone: 301-694-0606
  • Fax: 301-662-6928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00389600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC06716
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: