Provider Demographics
NPI:1932229259
Name:KIRK, SHELLY F (NP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:F
Last Name:KIRK
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:950 E MAIN ST
Mailing Address - Street 2:BLDG B
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-7409
Mailing Address - Country:US
Mailing Address - Phone:928-236-8001
Mailing Address - Fax:928-722-6113
Practice Address - Street 1:676 S BLUFF ST
Practice Address - Street 2:STE 207
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3596
Practice Address - Country:US
Practice Address - Phone:435-674-1700
Practice Address - Fax:435-359-1427
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2020-06-15
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Provider Licenses
StateLicense IDTaxonomies
AZ238878363L00000X
UT1966924405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005801202Medicare ID - Type Unspecified