Healthcare Provider Details

I. General information

NPI: 1003699562
Provider Name (Legal Business Name): STEPHANIE MARIE KIRK MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 ESCALANTE DR STE 201
DURANGO CO
81303-8932
US

IV. Provider business mailing address

1305 ESCALANTE DR STE 201
DURANGO CO
81303-8932
US

V. Phone/Fax

Practice location:
  • Phone: 970-247-0042
  • Fax: 970-259-8837
Mailing address:
  • Phone: 970-247-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0999028
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: