Provider Demographics
NPI:1457635062
Name:SHIRK, KATHY SULLIVAN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:SULLIVAN
Last Name:SHIRK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 FORD ST
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-4105
Mailing Address - Country:US
Mailing Address - Phone:412-469-8649
Mailing Address - Fax:
Practice Address - Street 1:403 FORD ST
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-4105
Practice Address - Country:US
Practice Address - Phone:412-469-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP000055A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA054258KDJMedicare UPIN