Provider Demographics
NPI:1235905936
Name:KIRK, KRISTY
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:MAXWELTON
Mailing Address - State:WV
Mailing Address - Zip Code:24957-8066
Mailing Address - Country:US
Mailing Address - Phone:304-497-0500
Mailing Address - Fax:304-497-0516
Practice Address - Street 1:804 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:MAXWELTON
Practice Address - State:WV
Practice Address - Zip Code:24957-8066
Practice Address - Country:US
Practice Address - Phone:304-497-0500
Practice Address - Fax:304-497-0516
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2084P0800X2084P0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry