Provider Demographics
NPI:1346120938
Name:KIRWAN, CONNOR MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:MICHAEL
Last Name:KIRWAN
Suffix:
Gender:M
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 1:917 9TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2506
Mailing Address - Country:US
Mailing Address - Phone:605-730-2982
Mailing Address - Fax:
Practice Address - Street 1:506 S WILSON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5082
Practice Address - Country:US
Practice Address - Phone:605-725-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1236697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant