Provider Demographics
NPI:1952492183
Name:KIRK, RICHARD NORMAN (NP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:NORMAN
Last Name:KIRK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9554
Mailing Address - Country:US
Mailing Address - Phone:707-963-3611
Mailing Address - Fax:
Practice Address - Street 1:1621 W IMOLA AVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-4721
Practice Address - Country:US
Practice Address - Phone:707-251-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10731363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952492183Medicaid
CA1952492183Medicaid
CAQ21074Medicare UPIN