Healthcare Provider Details

I. General information

NPI: 1154422962
Provider Name (Legal Business Name): CARYS A KIRK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PELHAM RD SUITE 1
SALEM NH
03079-2826
US

IV. Provider business mailing address

6 TSIENNETO RD STE 300
DERRY NH
03038-1584
US

V. Phone/Fax

Practice location:
  • Phone: 603-898-2244
  • Fax: 603-898-2227
Mailing address:
  • Phone: 603-216-0400
  • Fax: 603-216-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0447
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: