Healthcare Provider Details

I. General information

NPI: 1255718607
Provider Name (Legal Business Name): CALIN KIRK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 E MELTON DR
JAY OK
74346-2704
US

IV. Provider business mailing address

859 E MELTON DR
JAY OK
74346-2704
US

V. Phone/Fax

Practice location:
  • Phone: 918-253-1700
  • Fax: 918-253-3287
Mailing address:
  • Phone: 918-253-1700
  • Fax: 918-253-3287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31687
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: