Provider Demographics
NPI:1679018659
Name:KIRK, HEATHER (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GUFFEY ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551-4089
Mailing Address - Country:US
Mailing Address - Phone:931-243-2651
Mailing Address - Fax:931-243-4132
Practice Address - Street 1:115 GUFFEY ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551-4089
Practice Address - Country:US
Practice Address - Phone:931-243-2651
Practice Address - Fax:931-243-4132
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000055492164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse