Healthcare Provider Details

I. General information

NPI: 1609145309
Provider Name (Legal Business Name): CORINNA JAY KIRKPATRICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2011
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 MOOSIC ST
SCRANTON PA
18505-2105
US

IV. Provider business mailing address

130 CAROL DR
CLARKS SUMMIT PA
18411-1922
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-1101
  • Fax: 570-348-6194
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA055355
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: