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General NPI Number Information
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NPI Number | 1407587835
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Entity Type | Individual
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Provider Name | KIRKLIN TUCKER MITCHELL PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 700 FOULK RD
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City | WILMINGTON
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State | DE
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Zip | 19803-3708
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Country | US
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Telephone | 302-764-0181
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Fax |
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Provider Business Mailing Address
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Address Line | 700 FOULK RD
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City | WILMINGTON
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State | DE
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Zip | 19803-3708
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Country | US
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Telephone | 302-764-0181
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Fax |
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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 | OA006145
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C5-0011925
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License Number State | DE
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