Individual
CANDACE KIRK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4680 WAVERLY FARMS RD, MILLINGTON, TN 38053-8146
(901) 616-3126
Mailing address
PO BOX 1702, MILLINGTON, TN 38083-1702
(901) 616-3126
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
115003584
TN
343900000X
Non-emergency Medical Transport (VAN)
Primary
115003584
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q020829
—
TN
Enumeration date
05/10/2016
Last updated
05/10/2016
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