Healthcare Provider Details

I. General information

NPI: 1376575969
Provider Name (Legal Business Name): PATRICIA A KIRK DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9486 HIGHWAY 412 W
LEXINGTON TN
38351-5713
US

IV. Provider business mailing address

9486 HIGHWAY 412 W
LEXINGTON TN
38351-5713
US

V. Phone/Fax

Practice location:
  • Phone: 731-249-5230
  • Fax: 731-506-4888
Mailing address:
  • Phone: 731-249-5230
  • Fax: 731-506-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number687
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number687
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: