Healthcare Provider Details

I. General information

NPI: 1568845287
Provider Name (Legal Business Name): JORDAN KIRK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN KIRK DO

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOSPITAL RD
WHITESBURG KY
41858-7627
US

IV. Provider business mailing address

240 HOSPITAL RD
WHITESBURG KY
41858-7627
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-3500
  • Fax:
Mailing address:
  • Phone: 606-633-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: