Healthcare Provider Details

I. General information

NPI: 1942019294
Provider Name (Legal Business Name): DONELLE KAY KIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S PORTLAND AVE
HARTINGTON NE
68739-5031
US

IV. Provider business mailing address

417 E MAIN ST
BLOOMFIELD NE
68718-2010
US

V. Phone/Fax

Practice location:
  • Phone: 402-649-0976
  • Fax:
Mailing address:
  • Phone: 402-649-0976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number88440426
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: