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General NPI Number Information
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NPI Number | 1972959757
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Entity Type | Individual
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Provider Name | CANDACE KIRK
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Gender | Female
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 4680 WAVERLY FARMS RD
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City | MILLINGTON
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State | TN
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Zip | 38053-8146
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Country | US
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Telephone | 901-616-3126
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1702
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City | MILLINGTON
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State | TN
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Zip | 38083-1702
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Country | US
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Telephone | 901-616-3126
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | 115003584
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 115003584
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License Number State | TN
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