Provider Demographics
NPI:1578838009
Name:KIRK, LORI (NP-C)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5161 B DR S
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9345
Mailing Address - Country:US
Mailing Address - Phone:269-969-6099
Mailing Address - Fax:269-969-6089
Practice Address - Street 1:5161 B DR S
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9345
Practice Address - Country:US
Practice Address - Phone:269-969-6099
Practice Address - Fax:269-969-6089
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704254430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily