Provider Demographics
NPI:1710417498
Name:KIRK, RACHEL ALLYN (DO)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ALLYN
Last Name:KIRK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ALLYN
Other - Last Name:FENTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:945 BETHESDA DR STE 240
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1880
Mailing Address - Country:US
Mailing Address - Phone:614-255-6900
Mailing Address - Fax:614-255-6901
Practice Address - Street 1:945 BETHESDA DR STE 240
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1880
Practice Address - Country:US
Practice Address - Phone:614-255-6900
Practice Address - Fax:614-255-6901
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL51236207Q00000X
OH34.016466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine