MEDICARE: MEGAN KIRK

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1871462176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN KIRK

Provider Business Mailing Address
First Line	:	2042 DELAWARE TPKE
Second Line	:
City	:	CLARKSVILLE
State	:	NY
Zip	:	12041-1224
Country	:	US
Telephone Number	:	518-495-5385
Fax Number	:

Provider Business Practice Location Address
First Line	:	2042 DELAWARE TPKE
Second Line	:
City	:	CLARKSVILLE
State	:	NY
Zip	:	12041-1224
Country	:	US
Telephone Number	:	518-495-5385
Fax Number	:

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

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	06/03/2026

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