Provider Demographics
NPI:1932457769
Name:KIRK, MEGHAN LEIGH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:LEIGH
Last Name:KIRK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:MEGHAN
Other - Middle Name:LEIGH
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 LINWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2128
Mailing Address - Country:US
Mailing Address - Phone:419-341-6221
Mailing Address - Fax:
Practice Address - Street 1:509 LINWOOD CT
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2128
Practice Address - Country:US
Practice Address - Phone:419-341-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141208MIV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse