=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003857855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERRY KIRKMAN MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2006
-----------------------------------------------------
Last Update Date | 03/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21216 NORTHWEST FWY STE 520
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-4695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-955-7900
-----------------------------------------------------
Fax | 281-955-0700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21216 NORTHWEST FWY STE 520
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-4695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-955-7900
-----------------------------------------------------
Fax | 281-955-0700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | KERRY KIRKMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-955-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | L7776
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------