Provider Demographics
NPI:1518615160
Name:MCKOWN, KIRK (BOC COF)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:MCKOWN
Suffix:
Gender:M
Credentials:BOC COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1041
Mailing Address - Country:US
Mailing Address - Phone:304-872-9001
Mailing Address - Fax:304-872-3218
Practice Address - Street 1:3029 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1041
Practice Address - Country:US
Practice Address - Phone:304-872-9001
Practice Address - Fax:304-872-3218
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC54023225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVC54023OtherBOC COF