Provider Demographics
NPI:1518723436
Name:KIRK, KIM ROCHELLE (RN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ROCHELLE
Last Name:KIRK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SE SALMON DR
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8427
Mailing Address - Country:US
Mailing Address - Phone:541-923-5437
Mailing Address - Fax:
Practice Address - Street 1:1199 B AVE
Practice Address - Street 2:
Practice Address - City:TERREBONNE
Practice Address - State:OR
Practice Address - Zip Code:97760-9440
Practice Address - Country:US
Practice Address - Phone:541-923-4856
Practice Address - Fax:541-923-4825
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088006343RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse