Provider Demographics
NPI:1134671944
Name:QUIRK, KELLY DANA (CNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DANA
Last Name:QUIRK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ARCH ST
Mailing Address - Street 2:SUITE G2
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1429
Mailing Address - Country:US
Mailing Address - Phone:330-375-4100
Mailing Address - Fax:
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:SUITE G2
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-375-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019834363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology