Provider Demographics
NPI:1689499337
Name:KIRKPATRICK HEALTHCARE LLC
Entity type:Organization
Organization Name:KIRKPATRICK HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-903-6633
Mailing Address - Street 1:W8773 S AND D TOWN LINE RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53114-1324
Mailing Address - Country:US
Mailing Address - Phone:262-903-6633
Mailing Address - Fax:262-429-8547
Practice Address - Street 1:611 HARMONY DR
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-8800
Practice Address - Country:US
Practice Address - Phone:262-249-1960
Practice Address - Fax:262-249-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty