Provider Demographics
NPI:1902682909
Name:SHORT, KIRA MCKENZIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:MCKENZIE
Last Name:SHORT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOLLYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-9427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-4364
Practice Address - Country:US
Practice Address - Phone:302-422-3311
Practice Address - Fax:302-735-3845
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant