Individual
COURTNEY DIANA KIRKLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2351 S FM 51 STE 100, DECATUR, TX 76234-3778
(940) 626-8073
(940) 626-8137
Mailing address
PO BOX 2347, DECATUR, TX 76234-6161
(940) 626-8073
(940) 626-8137
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA5976963
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8NL737
BCBSTX
TX
05
—
PENDING
—
TX
Enumeration date
04/22/2019
Last updated
11/16/2020
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