Provider Demographics
NPI:1871197574
Name:KIRK, KRISTI
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27419 NEWCASTLE RD
Mailing Address - Street 2:
Mailing Address - City:GAMBIER
Mailing Address - State:OH
Mailing Address - Zip Code:43022-9765
Mailing Address - Country:US
Mailing Address - Phone:740-398-2095
Mailing Address - Fax:
Practice Address - Street 1:27419 NEWCASTLE RD
Practice Address - Street 2:
Practice Address - City:GAMBIER
Practice Address - State:OH
Practice Address - Zip Code:43022-9765
Practice Address - Country:US
Practice Address - Phone:740-398-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSH924186347C00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle