Healthcare Provider Details

I. General information

NPI: 1356455539
Provider Name (Legal Business Name): BARBARA KIRK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 4TH ST E
SAINT PAUL MN
55101-1421
US

IV. Provider business mailing address

166 4TH ST E
SAINT PAUL MN
55101-1421
US

V. Phone/Fax

Practice location:
  • Phone: 651-292-2009
  • Fax: 651-292-2178
Mailing address:
  • Phone: 651-292-2009
  • Fax: 651-292-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR112157-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: