Provider Demographics
NPI:1619555133
Name:MINOR, NICOLE KIRKWOOD (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KIRKWOOD
Last Name:MINOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ALEXIS
Other - Last Name:KIRKWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13934 STANLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1283
Mailing Address - Country:US
Mailing Address - Phone:804-754-5140
Mailing Address - Fax:
Practice Address - Street 1:7521 RIGHT FLANK RD STE 100
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3871
Practice Address - Country:US
Practice Address - Phone:804-559-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102208480208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics