=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508814096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARON M. KIRKLAND, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 01/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6700 S FLORIDA AVE SUITE 16
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33813-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-619-6555
-----------------------------------------------------
Fax | 863-619-6555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6700 S FLORIDA AVE SUITE 16
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33813-3327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-619-6555
-----------------------------------------------------
Fax | 863-619-6555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. SHARON M. KIRKLAND
-----------------------------------------------------
Credential | L.C.S.W
-----------------------------------------------------
Telephone | 863-619-6555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW 1915
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------