Provider Demographics
NPI:1407851876
Name:KIRK, AMY M (CNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:KIRK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:393 E TOWN ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4741
Mailing Address - Country:US
Mailing Address - Phone:614-252-1500
Mailing Address - Fax:614-252-1685
Practice Address - Street 1:393 E TOWN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4741
Practice Address - Country:US
Practice Address - Phone:614-252-1500
Practice Address - Fax:614-252-1685
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08105NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2547453Medicaid
Q36282Medicare UPIN
WONP17481Medicare ID - Type Unspecified