Provider Demographics
NPI:1942314539
Name:KIRK, LISA CAROL (CFNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CAROL
Last Name:KIRK
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 ASHLAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-1067
Mailing Address - Country:US
Mailing Address - Phone:423-581-4619
Mailing Address - Fax:
Practice Address - Street 1:350 E ECONOMY RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3327
Practice Address - Country:US
Practice Address - Phone:423-318-6093
Practice Address - Fax:423-318-9326
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3906306Medicaid
3906306Medicare ID - Type Unspecified
P06898Medicare UPIN