Healthcare Provider Details

I. General information

NPI: 1720592066
Provider Name (Legal Business Name): KIMBERLY L KIRK MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2017
Last Update Date: 05/24/2020
Certification Date: 05/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 8TH AVE N
BILLINGS MT
59101-1107
US

IV. Provider business mailing address

610 S 44TH ST W APT 5109
BILLINGS MT
59106-3956
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-5200
  • Fax:
Mailing address:
  • Phone: 719-684-5809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: