Nicole Kirkman
Individual provider Active NPI Contractor · Villa Grove, IL
NPI 1962885152 · NPPES record last updated Jul 7, 2015
Key facts
- NPI
- 1962885152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 160.003652 (IL)
- Practice address
- 407 N Henson Rd
Villa Grove, IL 61956-1321 - Phone
- (217) 714-9232
- NPI assigned
- Jul 7, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.003652 | IL | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 160.003652 | IL | Yes |
Addresses
Primary practice location
407 N Henson Rd
Villa Grove, IL 61956-1321
Mailing address
407 N Henson Rd
Villa Grove, IL 61956-1321
Phone (217) 714-9232
Other providers in Villa Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.