Provider Demographics
NPI:1407232010
Name:KIRK, KALEE
Entity Type:Individual
Prefix:
First Name:KALEE
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:PO BOX 1367
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75483-1367
Mailing Address - Country:US
Mailing Address - Phone:903-885-3181
Mailing Address - Fax:903-885-1329
Practice Address - Street 1:105 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482
Practice Address - Country:US
Practice Address - Phone:903-885-3181
Practice Address - Fax:903-885-1329
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-007OtherTRICARE
TXP01912519OtherMEDICARE RAIL ROAD
TX75-2616977-129OtherTRICARE
TX8HD650OtherBCBS
TX369819302Medicaid
TX596475YNSXOtherMEDICARE
TX75-2616977-002OtherTRICARE
TX8404MBOtherBCBS
TX75-2616977-028OtherTRICARE
TX75-2616977-001OtherTRICARE
TX75-0818167-022OtherTRICARE