Provider Demographics
NPI:1679234009
Name:KIRK, BRANDY ALICIA (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:BRANDY
Middle Name:ALICIA
Last Name:KIRK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8837 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2115
Mailing Address - Country:US
Mailing Address - Phone:219-742-4005
Mailing Address - Fax:
Practice Address - Street 1:1 PARK ROW ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-6597
Practice Address - Country:US
Practice Address - Phone:219-874-7256
Practice Address - Fax:219-879-9839
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012078A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner