Provider Demographics
NPI:1912934084
Name:KIRK, KATHRYN (APN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:APN
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 2652
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78299-2652
Mailing Address - Country:US
Mailing Address - Phone:254-495-7702
Mailing Address - Fax:
Practice Address - Street 1:1006 E 18TH ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-2016
Practice Address - Country:US
Practice Address - Phone:254-495-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239473363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
00Z020OtherMEDICARE GROUP #
TX029330002Medicaid
00954UOtherC&K GROUP MCB #
TX029330003Medicaid
TX029330003Medicaid
8A5928Medicare PIN