Basic Information
Provider Information
NPI: 1275273732
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIRKPATRICK
FirstName: KENNEDY
MiddleName: PAIGE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: DEPARTMENT OF ANESTHESIOLOGY ONE BAYLOR PLAZA
Address2: MS:BCM120
City: HOUSTON
State: TX
PostalCode: 77030
CountryCode: US
TelephoneNumber: 7137987356
FaxNumber: 7137986374
Practice Location
Address1: BEN TAUB HOSPITAL 1504 TAUB LOOP
Address2:  
City: HOUSTON
State: TX
PostalCode: 77030
CountryCode: US
TelephoneNumber: 7138732000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/31/2022
LastUpdateDate: 03/31/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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