Provider Demographics
NPI:1568845287
Name:KIRK, JORDAN (DO)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:240 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-7627
Mailing Address - Country:US
Mailing Address - Phone:606-633-3500
Mailing Address - Fax:
Practice Address - Street 1:240 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7627
Practice Address - Country:US
Practice Address - Phone:606-633-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health