Healthcare Provider Details

I. General information

NPI: 1447645775
Provider Name (Legal Business Name): AMITY LORRAINE KIRKLAND D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YELLOWHAWK TRIBAL HEALTH CENTER 46314 TIMINE WAY
PENDLETON OR
97801
US

IV. Provider business mailing address

YELLOWHAWK TRIBAL HEALTH CTR PO BOX 160
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax:
Mailing address:
  • Phone: 541-966-9830
  • Fax:

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 Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number36.003874
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: