Provider Demographics
NPI:1912963026
Name:KIRK, CELESTA V (FNP)
Entity Type:Individual
Prefix:
First Name:CELESTA
Middle Name:V
Last Name:KIRK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 W ELK AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2895
Mailing Address - Country:US
Mailing Address - Phone:423-542-8929
Mailing Address - Fax:423-542-8621
Practice Address - Street 1:1497 W ELK AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2895
Practice Address - Country:US
Practice Address - Phone:423-542-8929
Practice Address - Fax:423-542-8621
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN05038363LF0000X
VA0024169706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507262Medicaid
VAP01227719OtherRAILROAD MEDICARE
VA1912963026Medicaid
VAP01227719OtherRAILROAD MEDICARE
TN1507262Medicaid
TN39099311Medicare PIN