MEDICARE: MRS. STEPHANIE KIRK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA52048	CA

General Provider Information

NPI Number	:	1013314442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE KIRK PA-C

Provider Business Mailing Address
First Line	:	29826 HAUN RD
Second Line	:	SUITE 302
City	:	MENIFEE
State	:	CA
Zip	:	92586-6546
Country	:	US
Telephone Number	:	951-672-1911
Fax Number	:	951-672-8406

Provider Business Practice Location Address
First Line	:	29826 HAUN RD
Second Line	:	SUITE 302
City	:	MENIFEE
State	:	CA
Zip	:	92586-6546
Country	:	US
Telephone Number	:	951-672-1911
Fax Number	:	951-672-8406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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