Provider Demographics
NPI:1629325618
Name:KIRK, JEWEL LEIGH (CRNP)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:LEIGH
Last Name:KIRK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 BOWERMAN RD
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35031-4440
Mailing Address - Country:US
Mailing Address - Phone:205-368-5972
Mailing Address - Fax:
Practice Address - Street 1:9288 STOUTS RD
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:AL
Practice Address - Zip Code:35091-2005
Practice Address - Country:US
Practice Address - Phone:205-368-5972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-097819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily