Healthcare Provider Details

I. General information

NPI: 1174204978
Provider Name (Legal Business Name): PADRAIG KIRKWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SALISBURY CIR
BRIDGEPORT WV
26330-1589
US

IV. Provider business mailing address

19 SALISBURY CIR
BRIDGEPORT WV
26330-1589
US

V. Phone/Fax

Practice location:
  • Phone: 304-709-2386
  • Fax:
Mailing address:
  • Phone: 304-709-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1234100
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: