Healthcare Provider Details

I. General information

NPI: 1396991121
Provider Name (Legal Business Name): TAMMY KIRKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 MAPLE ST
GREENSBORO NC
27405-6910
US

IV. Provider business mailing address

4207 BAYVIEW RD
GREENSBORO NC
27405-9536
US

V. Phone/Fax

Practice location:
  • Phone: 336-641-3331
  • Fax: 336-641-6693
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number096490
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: