Provider Demographics
NPI:1972013670
Name:KIRK, BRIELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIELLE
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N CAPITAL OF TEXAS HWY STE 125
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-3302
Mailing Address - Country:US
Mailing Address - Phone:512-443-9355
Mailing Address - Fax:
Practice Address - Street 1:500 N CAPITAL OF TEXAS HWY STE 125
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-3302
Practice Address - Country:US
Practice Address - Phone:512-443-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-07
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11497363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant