Provider Demographics
NPI:1235161829
Name:KIRK, ELIZABETH ANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:KIRK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8060 COUNTS MASSIE RD INTEGRATED CARE PROFESSIONALS
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6657
Mailing Address - Country:US
Mailing Address - Phone:479-968-8279
Mailing Address - Fax:479-250-0500
Practice Address - Street 1:8060 COUNTS MASSIE RD INTEGRATED CARE PROFESSIONALS
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6657
Practice Address - Country:US
Practice Address - Phone:479-968-8279
Practice Address - Fax:479-250-0500
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS001061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W668OtherAR BLUECROSS BLUESHIELDE
AR5W668OtherAR BLUECROSS BLUESHIELDE