Healthcare Provider Details

I. General information

NPI: 1003126533
Provider Name (Legal Business Name): MARY C KIRK MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE SUITE 310
TULSA OK
74136-7823
US

IV. Provider business mailing address

6465 S YALE AVE SUITE 310
TULSA OK
74136-7823
US

V. Phone/Fax

Practice location:
  • Phone: 918-236-3000
  • Fax: 918-236-3060
Mailing address:
  • Phone: 918-236-3000
  • Fax: 918-236-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number17797
License Number StateOK

VIII. Authorized Official

Name: MARY CAROLYN KIRK
Title or Position: PRESIDENT
Credential: MD
Phone: 918-236-3000