Provider Demographics
NPI:1770941197
Name:KIRK, PATRICK (BA, MS, CPSS, CFSP)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:KIRK
Suffix:
Gender:M
Credentials:BA, MS, CPSS, CFSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 W OVERLAND RD STE 301
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-3077
Mailing Address - Country:US
Mailing Address - Phone:208-801-6806
Mailing Address - Fax:208-694-6301
Practice Address - Street 1:6003 W OVERLAND RD STE 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3076
Practice Address - Country:US
Practice Address - Phone:208-982-7701
Practice Address - Fax:208-694-6301
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-30
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 175T00000X, 343900000X, 175T00000X
ID251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist
No251B00000XAgenciesCase Management
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)