Healthcare Provider Details

I. General information

NPI: 1275472425
Provider Name (Legal Business Name): IAN KIRKPATRICK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 BUDLEIGH ST
MANTEO NC
27954
US

IV. Provider business mailing address

305 BACK RD
OCRACOKE NC
27960-1007
US

V. Phone/Fax

Practice location:
  • Phone: 252-300-3005
  • Fax: 252-473-1781
Mailing address:
  • Phone: 252-300-3005
  • Fax: 252-473-1781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16338
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: