Provider Demographics
NPI:1639847437
Name:KIRK, ANDREA JEAN LOUISE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN LOUISE
Last Name:KIRK
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:JEAN LOUISE
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANDREA PAULSON
Mailing Address - Street 1:14050 37TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5405
Mailing Address - Country:US
Mailing Address - Phone:651-403-0353
Mailing Address - Fax:
Practice Address - Street 1:6401 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2104
Practice Address - Country:US
Practice Address - Phone:952-924-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8494363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care