Provider Demographics
NPI:1285853341
Name:AUSTBO, KIRK WILLIAM (RN, BSN)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:WILLIAM
Last Name:AUSTBO
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 OAK ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1266
Mailing Address - Country:US
Mailing Address - Phone:541-282-3970
Mailing Address - Fax:541-734-3961
Practice Address - Street 1:1911 HAZEL ST.
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-734-3950
Practice Address - Fax:541-734-3960
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health