Provider Demographics
NPI:1033363189
Name:KIRK, JENNIFER SMITH (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SMITH
Last Name:KIRK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KAY
Other - Last Name:SMITH (HATTON)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1540 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3012
Mailing Address - Country:US
Mailing Address - Phone:334-793-2618
Mailing Address - Fax:334-792-7353
Practice Address - Street 1:1540 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3012
Practice Address - Country:US
Practice Address - Phone:334-793-2618
Practice Address - Fax:334-792-7353
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-096853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily