Healthcare Provider Details

I. General information

NPI: 1558865204
Provider Name (Legal Business Name): JESSICA MARY KIRKLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MARY KIRKLAND MD

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 E GALBRAITH RD
CINCINNATI OH
45236-2725
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5281
  • Fax: 513-558-5791
Mailing address:
  • Phone: 513-245-3613
  • Fax: 513-585-5511

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 Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.142361
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: