Healthcare Provider Details

I. General information

NPI: 1750031654
Provider Name (Legal Business Name): CASSIDY KIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 GRANT ST
SCANDIA KS
66966-8119
US

IV. Provider business mailing address

411 GRANT ST
SCANDIA KS
66966-8119
US

V. Phone/Fax

Practice location:
  • Phone: 720-471-4509
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: