Provider Demographics
NPI:1023100161
Name:LITTLE, KIRK DAVID (PSYD)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:DAVID
Last Name:LITTLE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 HOUSTON RD
Mailing Address - Street 2:BUILDING 500, SUITE 11
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4884
Mailing Address - Country:US
Mailing Address - Phone:859-525-4911
Mailing Address - Fax:859-525-6446
Practice Address - Street 1:6900 HOUSTON RD
Practice Address - Street 2:BUILDING 500, SUITE 11
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4884
Practice Address - Country:US
Practice Address - Phone:859-525-4911
Practice Address - Fax:859-525-6446
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000227535OtherINSURANCE PROVIDER NUMBER
KY89000905Medicaid
KY89000905Medicaid