Provider Demographics
NPI:1811340698
Name:KIRK, ANITA L
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:L
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 1:225 N WATER AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-2825
Mailing Address - Country:US
Mailing Address - Phone:918-458-4130
Mailing Address - Fax:918-458-4132
Practice Address - Street 1:225 N WATER AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2825
Practice Address - Country:US
Practice Address - Phone:918-458-4130
Practice Address - Fax:918-458-4132
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide