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General NPI Number Information
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NPI Number | 1942401484
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Entity Type | Organization
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Legal Business Name | STEPHEN W KIRLEY MD PA
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 2554 LEWISVILLE CLEMMONS RD SUITE 310
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City | CLEMMONS
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State | NC
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Zip | 27012-8110
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Country | US
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Telephone | 336-766-7241
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Fax | 336-766-9143
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Provider Business Mailing Address
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Address Line | 2554 LEWISVILLE CLEMMONS RD SUITE 310
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City | CLEMMONS
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State | NC
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Zip | 27012-8110
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Country | US
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Telephone | 336-766-7241
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Fax | 336-766-9143
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEPHEN WALTER KIRLEY
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Credential | M.D.
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Telephone | 336-766-7241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C37095
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20153
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License Number State | NC
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