Provider Demographics
NPI:1336817527
Name:KIRK, LATORYA DENISE
Entity Type:Individual
Prefix:MISS
First Name:LATORYA
Middle Name:DENISE
Last Name:KIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 JAY ST NE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1831
Mailing Address - Country:US
Mailing Address - Phone:202-892-9679
Mailing Address - Fax:
Practice Address - Street 1:307 K ST NW APT 309
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3099
Practice Address - Country:US
Practice Address - Phone:202-713-2554
Practice Address - Fax:202-842-8427
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant