Healthcare Provider Details

I. General information

NPI: 1437174984
Provider Name (Legal Business Name): JANET L KIRK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
FPO AA
92055
US

IV. Provider business mailing address

PO BOX 555191
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1288
  • Fax: 760-725-1661
Mailing address:
  • Phone: 760-725-1288
  • Fax: 760-725-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA-1942-16
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2296
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4203
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: