Provider Demographics
NPI:1770603979
Name:KOYAMA, KIRK (RN, PHN, MSN, CNS)
Entity type:Individual
Prefix:MR
First Name:KIRK
Middle Name:
Last Name:KOYAMA
Suffix:
Gender:M
Credentials:RN, PHN, MSN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-0220
Mailing Address - Country:US
Mailing Address - Phone:928-674-7184
Mailing Address - Fax:
Practice Address - Street 1:HWY 191, HOSPITAL DR.
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503-0220
Practice Address - Country:US
Practice Address - Phone:928-674-7184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511644163WC1500X
CA2218364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health