Provider Demographics
NPI:1437820099
Name:KIRK, SHIRNITA
Entity Type:Individual
Prefix:
First Name:SHIRNITA
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 3
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-0003
Mailing Address - Country:US
Mailing Address - Phone:414-248-0252
Mailing Address - Fax:
Practice Address - Street 1:4050 N 24TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6668
Practice Address - Country:US
Practice Address - Phone:262-339-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No171M00000XOther Service ProvidersCase Manager/Care Coordinator