Provider Demographics
NPI:1487422937
Name:KIRKLAND, LAUREN ANDERSON (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ANDERSON
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 SYCAMORE AVE APT 1717
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6792
Practice Address - Country:US
Practice Address - Phone:864-318-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMPA.5058363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant