Provider Demographics
NPI:1003957192
Name:ZIRKLE, CARA L (RN)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:L
Last Name:ZIRKLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12003 OLD LOG HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:HARVEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66431-9288
Mailing Address - Country:US
Mailing Address - Phone:785-608-1963
Mailing Address - Fax:
Practice Address - Street 1:12003 OLD LOG HOUSE RD
Practice Address - Street 2:
Practice Address - City:HARVEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:66431-9288
Practice Address - Country:US
Practice Address - Phone:785-608-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-159044-071163W00000X
KSX02-18-5388172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100392130AMedicaid