Provider Demographics
NPI:1508239518
Name:KIRK, KATHLEEN (KATIE) BRIDGET (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN (KATIE)
Middle Name:BRIDGET
Last Name:KIRK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:BRIDGET
Other - Last Name:RINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41908 PICO WAY
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4720
Mailing Address - Country:US
Mailing Address - Phone:661-839-6756
Mailing Address - Fax:
Practice Address - Street 1:41908 PICO WAY
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4720
Practice Address - Country:US
Practice Address - Phone:661-839-6756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily