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General NPI Number Information
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NPI Number | 1083278311
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Entity Type | Individual
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Provider Name | COURTNEY DIANA KIRKLAND
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Gender | Female
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 2351 S FM 51 STE 100
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City | DECATUR
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State | TX
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Zip | 76234-3778
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Country | US
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Telephone | 940-626-8073
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Fax | 940-626-8137
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Provider Business Mailing Address
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Address Line | PO BOX 2347
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City | DECATUR
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State | TX
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Zip | 76234-6161
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Country | US
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Telephone | 940-626-8073
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Fax | 940-626-8137
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA5976963
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License Number State | TX
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