Healthcare Provider Details

I. General information

NPI: 1770838336
Provider Name (Legal Business Name): MR. PHILLIP JAMES KIRK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 S YALE AVE 215
TULSA OK
74136-5713
US

IV. Provider business mailing address

7010 S YALE AVE 215
TULSA OK
74136-5713
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-2554
  • Fax: 918-494-9870
Mailing address:
  • Phone: 918-492-2554
  • Fax: 918-494-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: