Healthcare Provider Details

I. General information

NPI: 1366599177
Provider Name (Legal Business Name): BRIANNA KIRK TER HAAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA LEIGH KIRK MD

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BLACKWELL ST
DURHAM NC
27701-3986
US

IV. Provider business mailing address

410 BLACKWELL ST
DURHAM NC
27701-3986
US

V. Phone/Fax

Practice location:
  • Phone: 877-844-8872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45287
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number2021-00872
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22408
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: