MEDICARE: MS. SUZANNE BENTLEY KIRK BS, MS, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704211265	MI

General Provider Information

NPI Number	:	1669479234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE BENTLEY KIRK BS, MS, FNP

Provider Business Mailing Address
First Line	:	810 BRIARCLIFF RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3857
Country	:	US
Telephone Number	:	517-414-4845
Fax Number	:

Provider Business Practice Location Address
First Line	:	1198 N WEST AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2047
Country	:	US
Telephone Number	:	517-789-1200
Fax Number	:	517-796-4547

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/09/2007

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